Information alert

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This diary is intended for patients undergoing thoracic surgery as a way of involving you in your recovery before your surgery as well as after. The diary is a part of the enhanced recovery pathway and aims to provide you with useful information and advice to get you moving more, eating better, stopping smoking and reducing complications after your procedure.

The enhanced recovery pathway is an evidence-based programme to help you get back to your baseline health and function as quickly as possible after surgery. The key components of the pathway can be summarised by the acronym “DREAMS”:

  • D = Discharge – it is important to think ahead and plan for your discharge to avoid delays in getting you home.
  • R = Review – the doctors and nurses will monitor you after surgery to make sure you are ready for discharge.
  • E = Eating and Drinking – good nutrition and hydration before and after surgery are vital as they give your body the energy and nutrients to repair.
  • A = Analgesia – effective pain relief will keep the pain at bay and will make it possible for you to take an active part in your rehabilitation.
  • M = Mobility – moving and exercising will improve your fitness before surgery and help with your recovery.
  • S = Sleep – regular rest and good quality sleep will give your body time to repair.

The enhanced recovery programme will:

  • Get you as fit as possible before surgery.
  • Reduce the mental and physical stress of the operation.
  • Lessen the experience of pain after surgery.
  • Decrease the length of time you spend in hospital.
  • Speed up your recovery.

Depending on your procedure, your hospital stay will range from an overnight stay to a few days. It is advisable to think about the type of support and help you might need once you are discharged and to have a plan in place ahead of your hospital admission.

After your surgery, you might need help at home with the following tasks:

  • Preparing meals
  • Grocery shopping
  • Housework such as cleaning and laundry
  • Childcare
  • Looking after your pets

Having a plan for who would be able to help you with these tasks after surgery would be beneficial. If no one is able to support you, and you think you will struggle, please make the team aware on admission. You will also need to consider your transport home from the hospital and may need to use a taxi service or get a lift from a friend or relative.

We recommend that you have a supply of over-the-counter pain relief tablets and laxatives at home in case you need them during your recovery period.

Aim to complete the following exercises 3 times a day.

Breathing exercises

Breathing exercises help to optimise your lung capacity and to clear any sputum before and after your operation.

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Shoulder exercises

After your thoracic surgery, you may experience shoulder pain and stiffness on the same side as the procedure. It is important to improve and maintain your shoulder movements before as well as after surgery which in turn will help with your recovery.

Shoulder flexion:

Start with your arm by your side. Raise your arm up in front of you, keeping your elbow straight.

Repeat 10 times for each arm.

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Shoulder abduction:

Start with your arm by your side. Raise your arm out to the side and all the way up, keeping your elbow straight and your palm down.

Repeat 10 times for each arm.

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Hands behind head:

Start with your hands behind your head. Gently push your elbows outwards whilst also squeezing your shoulder blades together.

Repeat 10 times.

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Hands behind back:

Try to get your hands together behind your back. You should feel a stretch at the front of your shoulders.

Repeat 10 times.

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Additional exercises

The ward has a small gym and an exercise ally which you can use after your surgery The therapy team will induct you to both the gym and the exercise ally during your stay and advise you on which exercises to complete.

You can find further information on a range of exercises suitable for different level of abilities on the NHS Live Well website.

Chest drains

After your procedure, you may wake up with one or two chest drains which will remove any excess air, blood or fluid that may collect in the chest. The drain(s) will not stop you from mobilising. The ward nurses and physiotherapists will show you how to manage your drain(s) whilst repositioning, getting out of bed and walking and will assist you when you need help. For more information about your chest drain(s), please see the Thoracic Surgery Booklet.

Eating and drinking

It is important to eat a balanced diet before and after your operation, including high protein and carbohydrate-rich foods. A good diet is associated with better outcomes after surgery, as it will strengthen your immune system and protect against infection, it will boost your energy levels and help repair skin, muscles and bones.

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Smoking cessation

Smoking can be associated with post-operative complications, so it is important to reduce and try to stop smoking completely before surgery. For advice on stopping smoking and nicotine replacement therapies speak to your GP, community pharmacy or contact a stop smoking service (see page 25 for details).

Fasting and carbohydrate loading

You are allowed to eat and drink as normal until midnight of the day before your surgery. You are allowed to drink water until 06:00 am.

Taking specialist carbohydrate-rich drinks on the morning of your operation can speed up your recovery and reduce your hospital stay. You will be asked to drink two 200 ml bottles of a carbohydrate drink between 05:00 am and 06:00 am on the morning of your surgery.

If you are diabetic, you will not have these supplementary carbohydrate loading drinks as they may increase your blood sugar levels.

It is important for your pain to be controlled well after your procedure. You may be provided with a Patient Controlled Analgesia (PCA) pump to help reduce your pain. When you press a button, the pump will deliver a small dose of pain relief. The pump is set up with a “lockout” interval for safe use, and the button can be pressed regularly to keep your pain to a minimum. The PCA is normally removed after 24 hours, and you will be prescribed oral pain relief. It is important to ask for additional pain relief if you need it.

You may also have a ‘paravertebral block’ pump or PVB which is inserted into the back while you are asleep in the anaesthetic room. It delivers local anaesthetic close to the spinal nerves and can be a very effective way to reduce your pain. Before your procedure, you will have an opportunity to discuss with the anaesthetist the most suitable pain relief option for you.

Many of the pain relief medications you will be given can make you constipated, so you will be prescribed regular laxatives which we recommend you take to avoid you becoming uncomfortable.


Fatigue is an extreme and persistent tiredness, weakness or exhaustion of mental and/or physical origin which is not relieved by rest. Most of us get tired, however, after your procedure and general anaesthetic you may feel fatigued. Your body and joints may feel heavy, your muscles may feel weaker and your mood and sleep may be affected.

Boom-and-bust cycle

During your post-operative recovery, there may be days when you may feel stronger and your activity may increase, which in turn could result in you feeling fatigued on the following day. This could become a cycle known as “boom-and-bust”.

You can overcome this cycle by being active, making time to rest and relax, by sleeping well and eating healthy food. The following few tips may also help you break the boom- and-bust cycle:

  • Prioritise - consider the tasks for the day or the week, including things you must do and things you would want and enjoy doing.
  • Plan - avoid doing too many high energy activities close together and plan ahead as much as possible.
  • Pace - break down complex tasks into more manageable, smaller parts and rest at regular intervals in-between.
  • Permission - allow yourself to take a break when you feel you need it, and don’t feel disheartened if you were unable to complete a certain task as you initially planned.

A chest infection or a clot in the vein, known as deep vein thrombosis (DVT), are some of the complications which may occur after surgery.

These complications may result from:

  • Anaesthesia – the use of anaesthetics can make the mucus in the lungs thick and sticky and more difficult to cough up.
  • Pain – whether from the operation site or your drain(s) may limit your ability to take deep breaths, cough effectively and mobilise.
  • Poor posture and decreased activity – staying in bed for long periods of time after surgery may hinder your recovery and increase the risk of developing complications.

Reduce the risk of these complications by:

  • Sitting in an upright position as much as possible to achieve good chest expansion.
  • Completing your breathing exercises regularly and use the Daily diary pages, as they will prompt you to follow your enhanced recovery programme.
  • Mobilising and sitting out of bed from day one after your surgery will be encouraged by the doctors nurses and physiotherapists.
  • Optimising your pain relief will make you comfortable and will allow you to mobilise regularly and cough effectively.

  • Rest - you may find it helpful to use breathing or guided relaxation strategies to calm your mind.
  • Keep active - try a small amount of light activity and rest afterwards. Aim to gradually increase your activity by doing a little bit more each time.
  • Routine - try to resume a daily routine for sleeping, eating and activities.
  • “Thinking” activities - keep your mind active and continue to focus on your interests such as reading, crafts, crosswords or conversations with friends.
  • Work - if you are in employment, please discuss your return to work and the need for a sick note with your surgeon and the specialist nurses.

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We are committed to continually improving our services for the benefit of future patients. Your experiences and opinions are valued and can help us improve our services.

Please take some time to complete the ‘NHS friends and family test’, which will be your opportunity to provide feedback on the quality of the care you received. The feedback will be used by the Department of Health to improve patient care and identify best performing hospitals.

You can complete the ‘NHS Friends and Family Test’ on the ward. Ask a member of staff for the test. This feedback is anonymous.

Patient Advice and Liaison Service (PALS)

Should you wish to make an enquiry or discuss a concern then please contact us by phone on 0203 447 3042 or email at If you are unable to contact us yourself, please could you provide consent for a family member or friend to act on your behalf.

If there is anything you would like to discuss with the thoracic surgery pre-assessment or the thoracic specialist nursing team, either before or after the surgery, please feel free to contact us on:

Telephone: 020 3456 6040 / 6041 / 6047 / 6053 Email:


For more information about your procedure, your hospital stay, postoperative recovery and the team looking after you, please see our Thoracic Surgery Booklet and the relevant Procedure Information Sheet you will be given prior to your admission.

If you have been transferred from another hospital, you can request these by speaking to the ward nurses, by calling us on 020 3456 6047 or emailing us at

































Page last updated: 10 June 2024

Review due: 01 June 2025