Information alert

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You have been referred by your chest physician for thoracic surgery, which is an operation involving your chest. This information is about how to prepare for your procedure, what would happen on the day of surgery and about your hospital stay and aftercare.

When your surgery date is confirmed, you will be advised by the surgical secretary or the pre-assessment team on the relevant admission details such as your pre- assessment appointment and admission pathway.

Before your admission into hospital, you will need to attend our thoracic pre-assessment clinic. You will spend time with our pre-assessment team who will answer your questions, go through your previous medical history and review the list of medications you are currently taking.

They will also advise you on what to expect during your hospital stay and recovery at home.

You will also have some or all of the following checks carried out:

  • VITAL SIGNS (blood pressure, heart and respiratory rate, oxygen levels, temperature)
  • BLOOD TESTS (including checking your blood group)
  • CHEST X-RAY (if required)
  • ECG (Electrocardiogram – a useful test which records the heart’s electrical activity)
  • MRSA (a simple nose swab to exclude methicillin-resistant staphylococcus aureus – a type of bacterial infection that is resistant to a number of widely used antibiotics). Screening helps reduce the chance of patients developing an MRSA infection or passing the infection on to other patients.
  • ANY OTHER TESTS (such as pregnancy test, COVID swab, spirometry)

You may be admitted on the same day of your surgery, in which case you will be expected at the hospital at 7:00am, or alternatively, your admission may be scheduled on the day before surgery. You will discuss the above options with the pre-assessment team, and you will receive clear instructions about the timing of your admission in order for you to make the necessary travel arrangements.

Occasionally, if emergency cases come into hospital or scheduled surgery is prolonged, your surgery may be cancelled and then rescheduled.

If you are taking any blood thinners (anticoagulants) such as Warfarin or Apixaban, or any antiplatelet tablets such as Aspirin or Clopidogrel, these may need to be stopped before your surgery. The decision will depend on the reason you are taking the blood thinners, and we may need to substitute them with an alternative (e.g. a small injection) for a few days leading up to your surgery. Your surgeon and pre- assessment team with advise and plan this for you.

The length of your hospital stay will depend on the type of procedure you are having, your post-operative recovery as well as your previous medical history. It could be one day or longer, and you will be able to discuss that with your surgeon and the pre-assessment team.

The following list includes some of the items you may want to consider bringing with you for your hospital stay:

  • Dressing gown, pyjamas, night dress (although not always comfortable when drains are in place)
  • Comfortable loose-fitting clothes
  • Shoes or trainers
  • Toilet bag and toiletries (no towel necessary)
  • Some money if you wish our volunteers to buy you some food whilst on the ward
  • Mobile phone, tablet, laptop including charger and headphones.
  • Book, magazine, crossword puzzle, pen / pencil
  • All medication that you normally take in their original boxes, including inhalers
  • Non-perishable snacks of your choice

Please don’t bring jewellery, valuables or large amounts of money and consider the length of your hospital stay as advised by your surgeon and the pre-assessment team so that you can pack accordingly. Before your operation, you will be asked to put on a hospital gown. If your hospital stay will be longer than a day, we encourage you to wear your own comfortable clothes on the ward.

We want you to play a full part in the decisions about your care. If you decide to go ahead with your procedure, by law, we must ask you to sign a consent form. This confirms that you agree to have surgery and understand what this means for you. Before signing your consent form, your surgeon will discuss with you the benefits and risks of surgery (taking into account your general health). Please, ask about anything that is on your mind. We want you to be fully informed about the procedure and confident about signing your consent form.

You may be asked to take part in a research study. If this happens, the research team will get in touch with you and provide you with information about their trial. If you agree to take part, you will be asked to sign a consent form allowing them to enrol you in their study.

  • THE SURGICAL TEAM – it consists of our five consultant surgeons, their specialist registrars and our senior house officer, who is based on the ward.
  • THE ANAESTHETIC TEAM – they will review your notes prior to your procedure and see you on the morning of your surgery. This is an opportunity for you to ask questions about the anaesthetic medication and pain relief after the operation.
  • THE SPECIALIST NURSING TEAM – the role of our Thoracic Clinical Nurse Specialist (CNS) team is to support you throughout your surgical experience, before your procedure as well as after, including when you go home after discharge.​​​​​​​
  • THE WARD NURSES – our thoracic ward nurses will look after you on the ward and plan your discharge with you and your family. They will take your observations, monitor the chest drains, liaise with the multidisciplinary team and advise you on your medications, wound care and anything else you may need.​​​​​​​
  • THERAPY TEAM – our therapy team will assess your function on day 1 after surgery and will provide you with rehabilitation to optimise your independence, aiming for you to return to your baseline level of function. The physiotherapist will also meet you on day 1 after your surgery. They will examine your chest to ensure that your lungs remain clear of sputum and teach you breathing exercises for you to do to prevent chest infection. The therapy team will assess and support you with your activities of daily living, and, if required, they will make onward referrals for support at home.
  • THE DIETICIAN - who can assess and advise you if you experience problems with your nutrition.​​​​​​​

  • THE PAIN NURSE - who can provide specialist advice on the management of your pain.​​​​​​​

  • THE PHARMACIST - who will monitor your medications.​​​​​​​

  • THE RELIGIOUS REPRESENTATIVE - if you would like someone to visit you, please discuss your wishes with your nurse or doctor.

Our Enhanced Recovery Programme is designed to optimise your rehabilitation and applies to the period before, during and after your procedure. For more information, please refer to your copy of the Enhanced Recovery Patient Diary, which you would have received in pre-assessment.

The day of your surgery can be a busy and overwhelming day, and we have summarised below all the important advice for you to consider and to follow through.

  • FASTING - you are allowed to eat and drink as normal on the day before your surgery. It is recommended that you do not drink alcohol, reduce your coffee and tea intake and increase your water intake. Please, do not eat after midnight. You may drink only water from midnight until 6:00am on the day of your surgery. After 06:00am you should be nil by mouth. Please, do not chew gum. If you are not diabetic, you will be given special carbohydrate- rich drinks, which you should take between 05:30 - 6:00am on the morning of your surgery, aiming to finish them by 6am.
  • HYGIENE AND SKIN CARE - we ask you to shower in the morning. Please, avoid using fragranced soap or shower gel and rinse your skin thoroughly. Do not apply any creams, lotions, deodorants or make-up thereafter and remove any nail polish or false nails. If your admission is the day before your procedure and you require help in the morning, please inform your ward nurse and they will assist you and prepare you for your operation. If you wear dentures, please remember to bring your denture pot which will be labelled by the nurses and stored until after your procedure.
  • YOUR PROPERTY - your belongings will be looked after while you are in the operation room and returned to you after your procedure. Please note, you may not always return to the same bed or the same ward after your operation, and the surgical and nursing team will keep you and your family informed.​​​​​​​
  • GOWN AND STOCKINGS - when it is time for your operation, you will change into a hospital gown and put on a pair of thromboembolic stockings (firm elastic socks to help prevent blood from collecting in the legs and causing clots). You will need to wear these socks until you are discharged home. After the surgery, you will be given small injections by your ward nurse to prevent the risk from blood clots.​​​​​​​
  • THE ANAESTHETIC ROOM - a member of staff will escort you to theatre where your personal details will be checked. Once in the anaesthetic room, the anaesthetist will insert into one of your veins a small flexible plastic tube called a cannula, which will be used to give you medications and fluids during and after your procedure. You will be attached to a cardiac monitor so that the team can view your vital signs while you are asleep. The length of time of your operation will depend on the type of​​​​​​​ procedure you are having, and your surgeon and anaesthetist will be able to advise you in more detail.

As you are waking up from the anaesthetic after your procedure, you may feel tired, thirsty or cold. You will first spend a period of time in our recovery area, where the recovery nurses will monitor your breathing and vital signs, optimise your pain relief and make you comfortable. When the team are happy with your progress, you will be moved to the ward or the Post Anaesthetic Care Unit (PACU) for further monitoring.

You are likely to have one or two chest drains, an intravenous infusion of fluids for hydration via a cannula and a painkiller given to you via a drip. Some patients may need a catheter in the bladder. These will be observed by the nurses and will be removed as soon as it is necessary and safe to do so.


To remove any extra fluid, blood or air from the chest, the surgeon will insert a drain. This is a flexible tube placed in the space between the lung and the chest wall. It will be attached to a collection bottle which may will be connected to a wall suction unit. The ward nurse will be monitoring the drain for the amount and type of drainage and will be checking whether any bubbles of air are present in the bottle. The chest drain or drains (if you have more than one) will be removed when they are no longer required.


After your operation, you will be given oxygen via a mask or via nasal cannulae so that your oxygen levels are maintained at the appropriate level.


Managing your pain well is essential for your rehabilitation and for preventing post-operative complications.

Before the operation, you will discuss with the anaesthetist your pain control options such as the Patient Controlled Analgesia (PCA) pump. By pressing a button, you will receive a small dose of intravenous pain relief medication. A green flashing light on the button will indicate when a dose is available. The pump is set up by the anaesthetist and programmed with a “lockout” period to ensure safe use. The PCA pump is normally discontinued 24 hours after surgery and converted to pain relief in a tablet form.

An infusion of local anaesthetic around the lung can also be used to help ease your pain after the operation. The anaesthetist will advise you whether this option will be suitable for you. Whichever type of pain relief you use, be sure to tell your nurse and doctor how well the prescribed medication is controlling your pain.


You may experience loss of appetite immediately after surgery. You can start to eat and drink when you feel ready, and you will be offered hot and cold drinks and a light meal a few hours after your procedure. You may also have some nausea and vomiting, caused by the anaesthetic and pain relief drugs, and you may take anti- sickness medication to resolve that. If it is necessary to optimise your nutrition before or after your operation, your nurses will refer you to a dietitian.


We encourage independence from day 1 after your surgery. The nursing staff and therapy team will encourage and assist you to get out of bed and mobilise. We advise you to try to walk to the bathroom to use the toilet and showers and will support you to do this where needed. It is important to sit out in a chair for all your meals. It is important for you to take an active part in your recovery and the physiotherapists, occupational therapist and nurses will be there to help you to do this. More information on this can be found in the Enhanced Recovery Patient Diary.


Regular bowel movement may be affected after your surgery. Anaesthesia, pain medication, changes in your diet and reduced mobility are all contributing factors.

Fibre-rich diet before your procedure is advisable. Afterwards, ensure that you drink plenty of fluids and move around whenever possible. It may be necessary for you to take laxatives for a period of time. You may also be offered suppositories or an enema to resolve your constipation prior to discharge.


Ensure you have all your usual medications with you. When you go home, we will supply you with any new medication you might need such as painkillers or laxatives, and your GP will provide you with any further supplies as needed. Purchasing over-the-counter painkillers such as Paracetamol ahead of your surgery is also a good idea so that you have a supply at home.

At the time of consent, your surgeon will explain the different approaches they use to gain access to the inside of your chest. After your surgery, your wound can vary from having two or three small incisions, which can be described as “keyholes”, or a bigger incision, which is known as a thoracotomy or a mini-thoracotomy.


Dissolvable sutures are most commonly used to join together the edges of the wound. Occasionally, the surgeon may decide to use glue, non-dissolvable sutures or (very rarely) staples.

Many thoracic patients will have one or two chest drains inserted at the time of surgery. Once your drain is removed, the nurses will tighten the suture your surgeon had inserted to keep it secure. This suture will need to stay in place for 10 days, allowing time for the wound to heal and close. You are advised to make an appointment with your practice nurse at your GP to have the suture taken out 10 days after your drain was removed.

Your wound will be covered with a waterproof dressing to protect it from infection, to absorb any leakage and to prevent any irritation from clothes rubbing. Before you go home, your nurse will check and clean your wound and reapply a new dressing. Feel free to ask your nurse to explain the steps while she is attending to your wound so that you are able to identify the sutures and manage your wound at home.

If your wound is dry and no fluid is leaking from the site, you can remove the waterproof dressing. Keyhole and drain site wounds can be exposed to air 2-3 days after surgery, and thoracotomy wounds can be exposed to air 5 days after surgery. You may shower but avoid too hot water and do not use soap near the surgical site as the skin will be sensitive.

Over the next 4-6 weeks after your surgery, avoid taking baths and always pat dry your wound with a clean gauze. We recommend that you change the bed linen prior to coming to hospital, continue to change them regularly thereafter and wear clean clothes to minimise infection.


When discharged, you will be given a supply of waterproof dressings, saline cleaning solution, a gauze and a suture cutter for the practice nurse to remove the suture when appropriate. If you need more supplies, you can call us or purchase these at your local pharmacy.

You may feel pain or discomfort when changing your dressing. To minimise this, we would recommend you take pain relief regularly and as prescribed. If you have pets in your home, please keep them in a different room when changing your dressing.


  1. Always wash your hands prior to touching your wound and prepare a clean area when you are to change your dressing.
  2. Remove the old wound dressing.
  3. Wash your hands a second time.
  4. Clean the wound with a sterile gauze and saline and then let it air dry.
  5. Inspect the wound for healing and signs of infection.
  6. Place a new wound dressing.


A wound infection is one of the rare complications you may come across after your surgery. Signs of infection may include:

  • Pain
  • Redness
  • Inflammation
  • Smell
  • Exudate (pus)

An infected wound needs medical attention and may need treatment. If you experience any of these symptoms, please call the thoracic Clinical Nurse Specialists and we can advise you.


Good nutrition is essential for your wound to heal. It can affect the speed your body heals, how strong your tissues become and your body’s resistance to fight infection during the healing process. A common side effect after your surgery is a loss of appetite. This can be a side effect of having general anaesthetic and the combination of medications you receive in hospital, such as the strong pain relief. Poor nutritional intake and unhealthy lifestyle choices such as smoking or drinking excessively will prevent your wound from healing properly, as it will take longer for the tissues to repair, and your wound will become more susceptible to infection.

Recovering from surgery can be difficult emotionally as well as physically, and you may have trouble sleeping or eating. Do share your worries with your family, friends or with your surgeon and nurse. They can help you through this difficult time and advise you on the support available to you. You will have received the contact details for the Thoracic CNS team, and you can call or email them if you have any questions or concerns.

Gradually, you will gain more energy and strength each day. Take things slowly and rest when you get tired. Your surgeon or specialist nurse will advise you on what you can and cannot do while you are recovering. If you live alone, it would be a good idea to plan for the period after your operation, for example, to complete a big shop with easy to cook meals. You may want to ask a family member or a friend to help you with shopping and heavier household chores for the first few weeks. We also advise you to you make arrangements for a relative or a friend to collect you when you are discharged.


We will give you one week’s supply of your pain medication to take home. It can take a while for the pain to resolve completely so you will need to visit your GP for further pain relief. You may feel numbness, burning and/ or tingling near the wound site, to the front of your chest or up your shoulder. In some patients, this may take up to six weeks or longer to fully settle. If you have any concerns, ensure that you contact the CNS team or seek advice from your GP.

Take your medications regularly and do not wait for the pain to become unbearable. It is important for you to be able to take a deep breath, cough, clear your secretions and move. In the event of a sudden onset of severe shortness of breath or sudden, sharp chest pain, which doesn’t resolve, you are advised to call an ambulance or go to your nearest emergency department as you may need a chest Xray.


It is important to return to your normal daily activities at home after your discharge from hospital. This initially may be more tiring than normal, and we advise you to pace yourself and use the fatigue management and breathlessness techniques which will be explained to you during your hospital stay.

Do not overexert yourself on “good days” and avoid heavy lifting and activities involving twisting, pushing and pulling with force. Recovery from surgery is individual, so do not feel disheartened if you are not making the progress you think you should be, but listen to your body and be guided by how you feel.

After 6 weeks, and if you feel ready and your pain is minimal, you can add more strenuous activities such as driving for short distances, hoovering, swimming, golf, cycling and others. Please, remember to rest as well and be guided by your body, pain levels and energy levels as to when to return to these activities.


We advise you to take action, such as calling you GP, the Thoracic Surgery CNS or the ward if out of hours, if you notice or experience any of the following:

  • Signs of infection: any fever or chills, redness, swelling, bleeding or excessive discharge from the incision site;
  • Increasing pain: this is pain you cannot control with the painkillers you were prescribed;
  • Worsening cough;
  • Difficulty breathing;
  • Chest pain;
  • Persistent nausea and/or vomiting;
  • Pain or swelling in your feet, calves, or legs.

DIAL 111 for non-emergency calls related to health

DIAL 999 for emergency calls related to health

If you are waiting to find out your biopsy results, please be aware that they are not available straight away. It takes two to three weeks for everything to be completed including the consideration of your results at the Lung Multidisciplinary Team meeting.

You will receive an appointment for your follow-up, which will usually happen at your local hospital or UCLH if we are your local trust. During your surgical follow-up, your overall recovery will be reviewed and your wound checked. You will also be given your histology results, and your care plan and / or any further treatment (if relevant) will be discussed with you and your family.

The Thoracic Clinical Nurse Specialist (CNS) Team

If there is anything you would like to discuss with 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:

Macmillan Support and Information Centre at the University College Hospital Macmillan Cancer Centre The Macmillan Support and Information Service is for anyone affected by cancer. Whether you are a patient, family member, friend or carer, they can offer support at any stage of your care pathway – from diagnosis, throughout treatment and beyond. They are located on the ground floor of the University College Hospital

Macmillan Cancer Centre and are open from 9am to 5pm, with drop-in support and information service in the Living Room starting from 9.30am.

Address: Huntley Street, London WC1E 6AG Tel: 020 3447 8663



Patient Advice and Liaison Service (PALS)

This is an easy to access, confidential service designed to assist patients, relatives and carers with questions, queries or complaints you may have.

Tel: 020 3447 3042


British Lung Foundation Helpline:

Tel: 03000 030 555


NHS Smokefree (Services to help you stop smoking) Website:

Cancer Research UK Nurse Helpline:

Tel: 0300 123 1022


The Roy Castle Foundation

Tel: 0333 323 7200



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Tel: 020 3456 3000 (Westmoreland reception)

Tel: 020 3456 7890 (UCLH main switchboard)


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Page last updated: 16 May 2024

Review due: 01 June 2025