Hospitalisation

After the operation, the patient is woken up in the operating room and then transferred to the recovery room, where they will stay for a few hours. The anesthetist and recovery room nurse ensure that the patient is stable and comfortable. The surgeon visits the patient to provide information about the operation and to enquire about the patient's post-operative condition. When clinical conditions are stable and pain is under control, the patient is transferred either to a room or to Continuing Care or Intensive Care.

• Intensive care:
  Depending on the type of operation, the patient's clinical condition, and the potential need for mechanical ventilation post-operation, the patient may be transferred directly from the operating room to the Intensive Care Unit (ICU). Once the patient no longer requires mechanical ventilation and/or their condition stabilizes sufficiently, they are transferred either to Continuing Care or directly to a regular room.

• Continuing care:
  In Continuing Care, the patient's vital signs are continuously monitored 24 hours a day. Once the patient no longer requires close monitoring, they are transferred to a regular room.

• Regular room:
  Here, the patient recovers from their operation and prepares to leave the hospital, either to return home or to a rehabilitation facility.

The healthcare team and the patient work closely together to manage pain as effectively as possible. There are several categories of painkillers, which are highly effective but may have side effects such as constipation, nausea, vomiting, headaches, drowsiness, or itching. The methods for administering these drugs are as follows:

• Epidural:
  This involves a small catheter positioned in the patient's back, through which local anesthetics and/or opiates (analgesics) are administered to relieve post-operative pain. The epidural is usually inserted by the anesthetist before the operation and left in place for a few days afterward. It is followed by pain-relieving tablets or subcutaneous injections.

• Intercostal block:
  At the end of the thoracoscopic operation, local anesthetics are injected along the intercostal nerves, which are located around each rib. This relieves pain for the first 6 hours post-operatively.

• Subcutaneous injections:
  Injections of morphine, a highly potent opiate, are given every 4 hours to control pain for the first few days after the operation.

• Oral tablets:
  When the drain is removed, pain is managed with oral medication. The pills are given at specific times, and the patient is also entitled to reserves. These drugs contain different molecules to attack the pain on several fronts. The patient will have to continue taking these drugs for a few weeks once at home.
  

• Incisions

The incisions depend on the approach used.

- For a thoracotomy, the incision will be 10-20 cm plus 1 or 2 other incisions of 1 cm for the thoracic tubes.
- For a thoracoscopy, there will be 1 to 3 incisions of around 1-3 cm.

• Stitches

After the operation, a wound plaster covers the wound for 48 hours, after which it is left to air. Generally, sutures are absorbable, meaning there is no need to remove the threads. However, for chest tube incisions, a thread is needed to close the wound once the tube has been removed. This is removed after 14 days, either at a follow-up appointment with the surgeon or by the attending physician.

• Cardiac monitoring
  

If the patient is in Intensive Care or Continuing Care, they will have 24-hour cardiac monitoring. This is done using electrodes stuck to the chest and connected to a screen.

• Bladder catheter
  

If the patient has an epidural, the risk of developing acute urinary retention (inability to empty the bladder) is very high. This is why a bladder catheter is inserted in the operating room before the operation and kept in place until the epidural is removed. Sometimes the anesthetic itself, especially in older men, can increase the probability of acute urinary retention. If this is the case, a bladder catheter will be inserted for 24 hours.

• Epidural catheter
  

If the patient has an epidural, they will have a catheter in the back connected to a continuous injection system. Depending on the level of pain, patients will also be able to inject reserves of the product themselves, at the touch of a button.

• Arterial catheter

If the patient is in Intensive Care or Continuing Care, they will have a catheter placed in an artery in the forearm to monitor blood pressure 24 hours a day and allow blood test to be taken.

• Central/peripheral venous catheter
  

A catheter in a peripheral vein (on the hand, for example) is used to inject fluids and drugs. It remains in place until the medication is administered orally. Sometimes, it is necessary to use a larger-caliber vein, in which case the catheter will be placed in the neck, clavicle, or groin.

• Oxygen
  

In the first few days after the operation, the patient may need oxygen. This is administered through the nasal cannula. If oxygen requirements are high, a mask may be applied around the mouth and nose. The oxygen will be withdrawn as soon as the saturation, measured using a finger-stick saturometer, is sufficient.

The length of hospitalization varies from patient to patient and depends on the type of operation.

• The average hospital stay for a thoracoscopy is 4-5 days
• While for a thoracotomy it is around 7 to 10 days.

The decision to return home will depend on the patient's recovery and will be made collaboratively between the patient and the healthcare team.