Recovering from surgery

• Immediately after surgery, you will be moved from the operating theatre to a large area nearby with medical monitoring equipment and specially trained staff. This is the recovery room. In some hospitals, it may be called a recovery ward or post-anaesthesia care unit. It might be a shared space or a private room.
• Some people who need a high level of care will go into the high dependency unit (HDU) or intensive care unit (ICU). This allows you to be closely monitored so potential problems can be identified and treated early. You will be moved out of the HDU or ICU as your condition improves. Your doctor will tell you before surgery if it’s likely you will be moved to one of these units.
• You may have had a tube down your throat during the surgery to help you breathe (intubation). This will be removed while you are under anaesthetic, but your mouth and throat may feel temporarily dry or sore.
• While the anaesthetic wears off, a nurse will monitor your vital signs, check the wound and your pain levels, and give you medicine or fluids to help you feel better and reduce side effects caused by the anaesthetic. You’ll probably receive pain medicine through a tube connected to a vein in your hand or arm (intravenous drip), and there might be some drains to remove waste and fluid from your body. The surgeon or anaesthetist may examine you again while you are in the recovery room.
• You will be moved from the recovery room once you have woken up from the anaesthetic.
• In some cases, people are allowed visitors while they are in the recovery room. Each hospital has different policies, e.g. only one visitor at a time. 

If you are staying in hospital to recover (i.e. you had surgery as an inpatient), you will be moved from the recovery room to a ward. You will be looked after by nurses and other health professionals, such as a physiotherapist or dietitian. If you have day surgery, you will usually be able to go home soon after the surgery.

While you are on the ward, nurses will check you regularly. They will usually take your blood pressure, pulse and temperature, check your wound and change the dressing as needed. You will be able to have visitors during the hospital’s visiting hours.

Tubes and drains

Depending on the surgery, you may have some tubes or drains attached to your body.

• Drip (intravenous infusion) in your hand or arm – gives you fluids until you can eat and drink normally. This may be in place for a few hours or a few days, depending on the surgery.
• Tube (drain) in the wound – drains excess fluid into a small bottle. This is usually removed after a few days.
• Small tube (catheter) in your bladder – to drain urine into a bag. This is usually removed when you start walking after surgery.
• Tube in the nose (nasogastric tube) – goes down into the stomach and removes fluid from the stomach until bowel function returns to normal.

Help with your recovery

While you are recovering on the hospital ward, the nurses will monitor your progress and help you with the following:

• Pain control – You may be given a PCA (patient-controlled analgesia) device, which is a pump that is connected to a drip or cannula that allows you to receive a dose of medicine when you press a button. The PCA is programmed to prevent you from overdosing.

  You may receive pain medicine as a tablet instead. Tell the doctor or nursing staff if you’re in pain or the pain worsens.

• Movement and circulation – When you return from theatre, you may be wearing compression stockings and/or have an injection of medicine to prevent blood clots forming in the deep veins of your legs (deep vein thrombosis or DVT).

  Try to get up and move around as much as possible to help your recovery and reduce the chance of blood clots or infections. The nurses or a physiotherapist will give you advice about this.

• Eating and drinking – Most people can start eating and drinking either the same day or the day after surgery. Some people begin by drinking broth and soup before progressing to plain foods and small meals, while others receive nutrition through a drip for a short while rather than eating.

  If the cancer and surgery affect your digestive system (e.g. mouth, throat, oesophagus, stomach, bowel), you will need to follow the dietitian’s advice about eating and drinking. 

• Bathing – The timing of your first shower depends on how you are feeling – some people shower the same day or the next day if they are up to it. The nurses will probably encourage you to shower as soon as possible because it is a good reason to get out of bed. They can help you if you need to remove dressings or cover them to keep them from getting wet. If you can’t get up and move, the nurses will help you bathe in bed.

Side effects of general anaesthetic

• Nausea and vomiting – You may feel nauseous or vomit within 24 hours of surgery, but there are medicines to control these side effects. Sometimes vomiting makes you feel better. Some people continue to feel nauseated for the first few days after they are discharged from hospital, but this will improve.
• Chills and dizziness – Your body may cool down after surgery, so you may feel cold and shiver. During the surgery and recovery, your temperature will be maintained, usually with warm blankets. Some
  people feel dizzy from the anaesthetic or because they may be dehydrated. You will be monitored to make sure you aren’t getting an infection.
• Mental effects – You may feel confused, groggy or ‘fuzzy’ in the minutes or hours after you wake up, and you may not remember why you had surgery. Most people make a full recovery within a few hours. In some cases, this may take days, particularly in elderly people and those who had memory problems before surgery.

  Rarely, people have ongoing mental effects (such as fogginess or mild memory loss) for a week or several months after surgery. This is called postoperative cognitive dysfunction. The reasons for this are unknown.

• Agitation – You might cry or feel restless and anxious when you wake up. Some people feel like their arms or legs are twitchy. This is a normal reaction.

  Tell your medical team if any of these side effects get worse or worry you.

Sometimes complications occur after surgery.

It’s very unlikely that all of the complications described here would be relevant to your situation. Your surgeon can give you a better idea of your actual risks.

Generally, the more complex the surgery is, the higher the chance of complications. Most complications are minor and can be treated easily; rarely, complications can have serious consequences.

• Infection – The biggest risk of infection after surgery is at the wound site, but infection can also occur in the chest and around the catheter site. There are some simple ways to prevent infections. Sometimes the doctor will prescribe medicine before surgery (prophylactic antibiotics). You will be monitored for signs of infection, such as redness around the wound or a discharge from the wound, cloudy urine, cough, shortness of breath and chest pain.
• Bleeding – Bleeding can happen inside the body (internally) or outside the body (externally). Internal bleeding can occur if a blood vessel breaks free after surgery, and external bleeding can occur if a wound opens up. Your medical team will manage any post-surgery bleeding. This could include giving you a blood transfusion or further surgery to stop bleeding.
• Blood clots or DVT – All surgery and some cancers increase the risk of developing blood clots in the deep veins of the legs or pelvis (deep vein thrombosis or DVT). There are ways to prevent this from occurring, including being given injections of anti-clotting drugs, wearing compression stockings during and after surgery, and using devices called pneumatic cuffs to keep the calf muscles moving during and sometimes after surgery. The nurses will also encourage you to get out of bed and move around as soon as you feel up to it.
• Lung problems – After surgery, it may be painful to breathe or cough for a period of time. You will be encouraged to do deep breathing exercises and to get out of bed and move around. Your medical team will monitor your breathing during your recovery and provide medicine to control any pain you have.
• Weak muscles (atrophy) – Although you’ll need to rest after surgery, it’s important to get up and move around. If you aren’t mobile, your muscles may get weak (atrophy). A nurse or physiotherapist may help you to get moving as soon as possible and give you advice about the best exercises to do. Generally, the sooner you are able to get up and move, the better your recovery will be.

If you have day surgery, you will be discharged from hospital after you leave the recovery room. It’s important to prearrange for someone to take you home after surgery. The nurses will contact this person to tell them when you’ll be ready to leave. 

If you have inpatient surgery, you will be discharged when the medical team thinks you are healthy enough to leave. Some people stay in hospital for a day or two, but others stay for longer – in some cases several weeks or, rarely, months.

Along with discharge papers, the medical team may give you:

• scan and test results
• instructions about recovering at home
• guidelines about when to contact your doctor
• a medical certificate for your employer
• insurance forms, bills or receipts
• a list of any medicines/prescriptions, or a small supply of medicines (such as pain relief).

If you want specific paperwork (e.g. a letter for your employer) and it isn’t offered, you can request it from the doctor, nurses, receptionist or social worker. You may want to make a copy for your records or to show to your GP, but in most cases, paperwork will be automatically sent to them.

Most people go home after discharge, but some go to an inpatient rehabilitation centre to help them get safely back on their feet and
return home.

Looking after yourself at home is one of the most important parts of your recovery.

Your rate of improvement and progress will depend on the type of surgery you have, what support you have at home, your overall fitness and health, and whether you are having other cancer treatments.

If you live alone, it’s a good idea to organise another adult to stay with you at home the first night after discharge, or to arrange to stay with family or friends.

When to call the doctor or go to the hospital

Contact your doctor immediately or go to the nearest hospital emergency department if you have any of the following symptoms:

• increased bleeding, swelling, redness, pus or drainage from the wound or around any tubes, drains or stomas
• a fever over 38˚C
• swelling in your limbs
• sudden, severe pain
• pain or burning when urinating
• nausea or vomiting for 12 hours or more
• trouble breathing, walking or doing things you could do before the surgery

Pain

The most common side effect of surgery is pain. Take pain relief medicine as prescribed by your health care team. If your pain isn’t under control, gets worse, or if the medicine causes side effects, talk to your GP.

If you are prescribed antibiotics, take the full course as instructed. You may feel better after a few days, but you will need to take the entire course to completely kill bacteria and prevent infection.

For more information about pain relief, read Cancer Council’s booklet Overcoming Cancer Pain.

Wound care

Your nurse will give you instructions about how to care for the wound. Clean it with mild soap and warm water and pat it dry, and avoid putting lotions or perfumes on the wound and the area around it. Your nurse will also explain how to change the dressings.

If adhesive strips have been used to close the wound, they should fall off within a few weeks, or you will be told when to remove them. If you remove the strips too soon, the wound might open. Your doctor or nurse will remove any stitches or staples during a follow-up appointment.

You might have some bruising around the surgical site, but this will fade over a few weeks. Try not to pick at any scabs around the wound, as this can cause infection.

Rest

Although it’s a good idea to stay active and do gentle exercise while you are recovering, it’s also important to follow your doctor’s advice about restrictions, such as avoiding heavy lifting. You may find that you tire easily and need to rest during the day. Get plenty of sleep and take breaks if you feel tired, and ask family or friends to assist you with household tasks, such as cooking. If you require home help services, speak to the hospital social worker or call Cancer Council 13 11 20 to find out what is available in your area.

Bathing

Unless you’ve been told otherwise, you will be able to shower. Wash your body as gently as possible and pat yourself dry. If you have dressings, you might need to keep them dry while you shower – your nurse will give you instructions.

Going to the toilet

Try not to strain when you go to the toilet, as this can cause small tears around the anus and swollen veins (haemorrhoids or piles). If you are taking strong pain medicine, you may also need to take medicine to help prevent constipation. If you haven’t had a bowel movement within a few days of the surgery, your pharmacist or doctor can give you advice or medicine to help.

Some people have trouble holding urine or bowel movements (incontinence) after surgery, especially abdominal surgery. This is usually temporary. Ask your surgeon or GP if you can speak to a continence nurse, who can help treat or manage this problem. For more information, call the National Continence Helpline on 1800 33 00 66 or visit continence.org.au or bladderbowel.gov.au.

Drains and tubes

Some people go home with a temporary drain or tube near the surgical site to collect extra fluid leaving the body. The hospital will usually organise a community nurse to visit you to empty the drain or tube.

Eating and drinking

Some people feel queasy after surgery. When you feel like eating, try basic foods such as rice and toast before going back to your usual diet (or following the special diet you were instructed to eat). Eat fibre and drink plenty of water to avoid constipation, and avoid alcohol, especially if you are taking medicine.

Activity

Try to do some gentle exercise to build up your strength. A physiotherapist can help you with this. Your doctor will discuss activities that should be avoided, such as heavy lifting, driving or sexual intercourse. It may be several weeks before you return to your usual activities. Read Cancer Council’s booklet Exercise for People Living with Cancer for more information.

You may also need some equipment to help you move safely, such as a walker, cane, shower chair or ramp. A physiotherapist or occupational therapist will show you how to use this equipment.

Lymphoedema

If the surgeon removes lymph nodes (glands) from your armpit or pelvic area, the lymph fluid may no longer drain properly and your arm or leg may swell. This is called lymphoedema. You may have to wear compression sleeves or stockings to manage this. For more information, call Cancer Council 13 11 20 or visit the Australasian Lymphology Association website at lymphoedema.org.au.

For some people, having cancer is like an emotional roller-coaster. You may have many mixed feelings before, during and after surgery. It’s natural to feel anxious, scared or angry.

When you return home, you might feel vulnerable or helpless. You may need help doing things you used to be able to do yourself, such as laundry or cooking. If your body has changed, it may affect your self-esteem.

If you have ongoing feelings of sadness and feel down most of the time, you may be depressed. Signs and symptoms of depression include:

• feeling overwhelmed, sad, irritable and frustrated
• not being able to concentrate
• withdrawing from other people
• relying on alcohol or drugs
• thinking life’s not worth living
• having trouble sleeping (insomnia).

Some of the physical symptoms of depression include tiredness and appetite loss, but these symptoms can also be caused by having surgery.

A range of effective treatments for depression are available, including counselling and medication. For information and ways to access services, talk to your GP, call Cancer Council 13 11 20, or go to beyondblue.org.au. Medicare rebates may be available for some treatments, such as seeing a counsellor or psychologist.

Surgery for cancer can affect your sexuality in physical and emotional ways. The impact of these changes depends on many factors, such as surgery side effects, your self-confidence and whether you have a partner. Although sexual intercourse may not be possible straightaway, closeness and sharing can still be part of your relationship.

If surgery for cancer might cause infertility, your doctor will discuss
the possibility of storing eggs, embryos and sperm before surgery.

Call Cancer Council 13 11 20 for free copies of Emotions and Cancer, Sexuality, Intimacy and Cancer and Fertility and Cancer,
or download digital versions from your local website.