Editing Surgery (section)

== Description of surgical procedure ==
=== Setting ===
[[Inpatient]] surgery is performed in a hospital, and the person undergoing surgery stays at least one night in the hospital after the surgery. [[Outpatient surgery]] occurs in a hospital outpatient department or freestanding ambulatory surgery center, and the person who had surgery is discharged the same working day.<ref name=LemosIAAS2006>{{cite book | veditors = Lemos P, Jarrett P, Philip B | title = Day surgery: development and practice | publisher = International Association for Ambulatory Surgery | location = London | year = 2006 | isbn = 978-989-20-0234-7 | url = http://www.iaas-med.com/files/historical/DaySurgery.pdf | access-date = 11 June 2018 | archive-date = 29 November 2020 | archive-url = https://web.archive.org/web/20201129170007/https://www.iaas-med.com/files/historical/DaySurgery.pdf | url-status = dead }}</ref> Office-based surgery occurs in a physician's office, and the person is discharged the same day.<ref name=Twersky2008>{{cite book | veditors = Twersky RS, Philip BK| title = Handbook of ambulatory anesthesia|edition=2nd| publisher = Springer | location = New York | year = 2008 | isbn = 978-0-387-73328-9|page=284|url=https://books.google.com/books?id=VJT_yygipvYC&pg=PA284}}</ref>

At a [[hospital]], modern surgery is often performed in an [[operating theater]] using [[surgical instrument]]s, an [[operating table]], and other equipment. Among United States hospitalizations for non-maternal and non-neonatal conditions in 2012, more than one-fourth of stays and half of hospital costs involved stays that included operating room (OR) procedures.<ref>{{cite web | vauthors = Fingar KR, Stocks C, Weiss AJ, Steiner CA | title = Most Frequent Operating Room Procedures Performed in U.S. Hospitals, 2003–2012 | work = HCUP Statistical Brief No. 186 | publisher = Agency for Healthcare Research and Quality | location = Rockville, MD | date = December 2014 | url = https://www.hcup-us.ahrq.gov/reports/statbriefs/sb186-Operating-Room-Procedures-United-States-2012.jsp | url-status=live | archive-url = https://web.archive.org/web/20150503163129/http://www.hcup-us.ahrq.gov/reports/statbriefs/sb186-Operating-Room-Procedures-United-States-2012.jsp | archive-date = 3 May 2015 | df = dmy-all }}</ref> The environment and procedures used in surgery are governed by the principles of [[aseptic technique]]: the strict separation of "sterile" (free of microorganisms) things from "unsterile" or "contaminated" things.  All surgical instruments must be [[Sterilization (microbiology)|sterilized]], and an instrument must be replaced or re-sterilized if it becomes contaminated (i.e. handled in an unsterile manner, or allowed to touch an unsterile surface). Operating room staff must wear sterile attire ([[Scrubs (clothing)|scrubs]], a scrub cap, a sterile surgical gown, sterile latex or non-latex polymer gloves and a surgical mask), and they must scrub hands and arms with an approved disinfectant agent before each procedure.

=== Preoperative care ===
{{main|Preoperative care}}
Prior to surgery, the person is given a [[medical examination]], receives certain pre-operative tests, and their [[physical fitness|physical status]] is rated according to the [[ASA physical status classification system]]. If these results are satisfactory, the person requiring surgery signs a consent form and is given a surgical clearance. If the procedure is expected to result in significant blood loss, an [[autologous]] [[blood donation]] may be made some weeks prior to surgery. If the surgery involves the [[digestive system]], the person requiring surgery may be instructed to perform a [[Whole bowel irrigation|bowel prep]] by drinking a solution of [[polyethylene glycol]] the night before the procedure. People preparing for surgery are also instructed to abstain from food or drink (an [[Nil per os|NPO order]] after midnight on the night before the procedure), to minimize the effect of stomach contents on pre-operative medications and reduce the risk of aspiration if the person vomits during or after the procedure.<ref name=":1" />

Some medical systems have a practice of routinely performing chest x-rays before surgery. The premise behind this practice is that the physician might discover some unknown medical condition which would complicate the surgery, and that upon discovering this with the chest x-ray, the physician would adapt the surgery practice accordingly.<ref name="ACRfive">{{Cite journal |author1 = American College of Radiology |author1-link = American College of Radiology |title = Five Things Physicians and Patients Should Question |journal = Choosing Wisely: An Initiative of the ABIM Foundation |url = http://www.choosingwisely.org/doctor-patient-lists/american-college-of-radiology/ |access-date = 17 August 2012 |url-status=live |archive-url = https://web.archive.org/web/20130210080213/http://www.choosingwisely.org/doctor-patient-lists/american-college-of-radiology/ |archive-date = 10 February 2013 }}, citing
* {{cite web|title=American College of Radiology ACR Appropriateness Criteria|url=http://www.choosingwisely.org/doctor-patient-lists/american-college-of-radiology/|publisher=American College of Radiology|access-date=4 September 2012|year=2000|url-status=live|archive-url=https://web.archive.org/web/20130210080213/http://www.choosingwisely.org/doctor-patient-lists/american-college-of-radiology/|archive-date=10 February 2013|df=dmy-all}} Last reviewed 2011.
* {{cite journal | vauthors = Gómez-Gil E, Trilla A, Corbella B, Fernández-Egea E, Luburich P, de Pablo J, Ferrer Raldúa J, Valdés M | title = Lack of clinical relevance of routine chest radiography in acute psychiatric admissions | journal = General Hospital Psychiatry | volume = 24 | issue = 2 | pages = 110–113 | year = 2002 | pmid = 11869746 | doi = 10.1016/s0163-8343(01)00179-7 }}
* {{cite journal | vauthors = Archer C, Levy AR, McGregor M | title = Value of routine preoperative chest x-rays: a meta-analysis | journal = Canadian Journal of Anaesthesia | volume = 40 | issue = 11 | pages = 1022–1027 | date = November 1993 | pmid = 8269561 | doi = 10.1007/BF03009471 | doi-access = free }}
* {{cite journal | vauthors = Munro J, Booth A, Nicholl J | title = Routine preoperative testing: a systematic review of the evidence | journal = Health Technology Assessment | volume = 1 | issue = 12 | pages = i–iv, 1–62 | year = 1997 | pmid = 9483155 | doi = 10.3310/hta1120 | doi-access = free }}
* {{cite journal | vauthors = Grier DJ, Watson LJ, Hartnell GG, Wilde P | title = Are routine chest radiographs prior to angiography of any value? | journal = Clinical Radiology | volume = 48 | issue = 2 | pages = 131–133 | date = August 1993 | pmid = 8004892 | doi = 10.1016/S0009-9260(05)81088-8 }}
* {{cite journal | vauthors = Gupta SD, Gibbins FJ, Sen I | title = Routine chest radiography in the elderly | journal = Age and Ageing | volume = 14 | issue = 1 | pages = 11–14 | date = January 1985 | pmid = 4003172 | doi = 10.1093/ageing/14.1.11 | doi-access = free }}
* {{cite journal | vauthors = Amorosa JK, Bramwit MP, Mohammed TL, Reddy GP, Brown K, Dyer DS, Ginsburg ME, Heitkamp DE, Jeudy J, Kirsch J, MacMahon H, Ravenel JG, Saleh AG, Shah RD | title = ACR appropriateness criteria routine chest radiographs in intensive care unit patients | journal = Journal of the American College of Radiology | volume = 10 | issue = 3 | pages = 170–174 | date = March 2013 | pmid = 23571057 | doi = 10.1016/j.jacr.2012.11.013 | url = http://guidelines.gov/content.aspx?id=35151 | access-date = 4 September 2012 | publisher = [[National Guideline Clearinghouse]] | url-status = dead | df = dmy-all | archive-url = https://web.archive.org/web/20120915185449/http://www.guidelines.gov/content.aspx?id=35151 | archive-date = 15 September 2012 | url-access = subscription }}</ref> However, [[Specialty (medicine)|medical specialty]] [[professional organizations]] recommend against routine pre-operative [[Chest radiograph|chest x-rays]] for people who have an unremarkable medical history and presented with a physical exam which did not indicate a chest x-ray.<ref name="ACRfive"/> Routine x-ray examination is more likely to result in problems like misdiagnosis, overtreatment, or other negative outcomes than it is to result in a benefit to the person.<ref name="ACRfive"/> Likewise, other tests including [[complete blood count]], [[prothrombin time]], [[partial thromboplastin time]], [[basic metabolic panel]], and [[urinalysis]] should not be done unless the results of these tests can help evaluate surgical risk.<ref name="ASCPfive">{{Citation |author1 = American Society for Clinical Pathology |author1-link = American Society for Clinical Pathology |title = Five Things Physicians and Patients Should Question |publisher = American Society for Clinical Pathology |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/american-society-for-clinical-pathology/ |access-date = 1 August 2013 |url-status=live |archive-url = https://web.archive.org/web/20130901115431/http://www.choosingwisely.org/doctor-patient-lists/american-society-for-clinical-pathology/ |archive-date = 1 September 2013 }}, which cites
#* {{cite journal | vauthors = Keay L, Lindsley K, Tielsch J, Katz J, Schein O | title = Routine preoperative medical testing for cataract surgery | journal = The Cochrane Database of Systematic Reviews | volume = 1 | pages = CD007293 | date = January 2019 | issue = 1 | pmid = 30616299 | pmc = 6353242 | doi = 10.1002/14651858.CD007293.pub4 }}
#* {{cite journal | vauthors = Katz RI, Dexter F, Rosenfeld K, Wolfe L, Redmond V, Agarwal D, Salik I, Goldsteen K, Goodman M, Glass PS | title = Survey study of anesthesiologists' and surgeons' ordering of unnecessary preoperative laboratory tests | journal = Anesthesia and Analgesia | volume = 112 | issue = 1 | pages = 207–212 | date = January 2011 | pmid = 21081771 | doi = 10.1213/ANE.0b013e31820034f0 | s2cid = 8480050 | doi-access = free }}
#* {{cite journal | vauthors = Munro J, Booth A, Nicholl J | title = Routine preoperative testing: a systematic review of the evidence | journal = Health Technology Assessment | volume = 1 | issue = 12 | pages = i–iv, 1–62 | year = 1997 | pmid = 9483155 | doi = 10.3310/hta1120 | doi-access = free }}
#* {{cite journal | vauthors = Reynolds TM | title = National Institute for Health and Clinical Excellence guidelines on preoperative tests: the use of routine preoperative tests for elective surgery | journal = Annals of Clinical Biochemistry | volume = 43 | issue = Pt 1 | pages = 13–16 | date = January 2006 | pmid = 16390604 | doi = 10.1258/000456306775141623 | doi-access = free }}
#* {{cite journal | vauthors = Capdenat Saint-Martin E, Michel P, Raymond JM, Iskandar H, Chevalier C, Petitpierre MN, Daubech L, Amouretti M, Maurette P | title = Description of local adaptation of national guidelines and of active feedback for rationalising preoperative screening in patients at low risk from anaesthetics in a French university hospital | journal = Quality in Health Care | volume = 7 | issue = 1 | pages = 5–11 | date = March 1998 | pmid = 10178152 | pmc = 2483578 | doi = 10.1136/qshc.7.1.5 }}</ref>

===Preparing for surgery===
{{More citations needed section|date=January 2019}}
A surgical team may include a surgeon, anesthetist, a circulating nurse, and a "scrub tech", or surgical technician, as well as other assistants who provide equipment and supplies as required. While informed consent discussions may be performed in a clinic or acute care setting, the pre-operative holding area is where documentation is reviewed and where family members can also meet the surgical team.  Nurses in the preoperative holding area confirm orders and answer additional questions of the family members of the patient prior to surgery. In the pre-operative holding area, the person preparing for surgery changes out of their street clothes and are asked to confirm the details of his or her surgery as previously discussed during the process of informed consent. A set of vital signs are recorded, a peripheral [[intravenous therapy|IV line]] is placed, and pre-operative medications (antibiotics, sedatives, etc.) are given.<ref>{{Cite web|url=https://medlineplus.gov/ency/patientinstructions/000578.htm|title=The day of your surgery – adult: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|access-date=2019-01-24}}</ref>

When the patient enters the operating room and is appropriately anesthetized, the team will then position the patient in an appropriate [[Surgical Positions|surgical position]]. If hair is present at the surgical site, it is clipped (instead of shaving). The skin surface within the [[operating field]] is cleansed and prepared by applying an [[antiseptic]] (typically [[chlorhexidine gluconate]] in alcohol, as this is twice as effective as [[povidone-iodine]] at reducing the risk of infection).<ref>{{cite journal | vauthors = Wade RG, Burr NE, McCauley G, Bourke G, Efthimiou O | title = The Comparative Efficacy of Chlorhexidine Gluconate and Povidone-iodine Antiseptics for the Prevention of Infection in Clean Surgery: A Systematic Review and Network Meta-analysis | journal = Annals of Surgery | volume = 274 | issue = 6 | pages = e481–e488 | date = December 2021 | pmid = 32773627 | doi = 10.1097/SLA.0000000000004076 | doi-access = free }}</ref>  Sterile drapes are then used to cover the borders of the [[operating field]].  Depending on the type of procedure, the cephalad drapes are secured to a pair of poles near the head of the bed to form an "ether screen", which separate the [[anesthetist]]/[[anesthesiologist]]'s working area (unsterile) from the surgical site (sterile).<ref>{{cite book| vauthors = Martin S |title=Minor Surgical Procedures for Nurses and Allied Healthcare Professionals|date=2007|publisher=John Wiley & Sons, Ltd|location=England|isbn=978-0-470-01990-0|page=122|url=https://books.google.com/books?id=EaDbhAO3kS8C&pg=PA113}}</ref>

[[Anesthesia]] is administered to prevent [[pain]] from the trauma of cutting, tissue manipulation, application of thermal energy, and suturing. Depending on the type of operation, anesthesia may be provided [[local anesthesia|locally, regionally]], or as [[general anesthesia]].  [[Spinal anesthesia]] may be used when the surgical site is too large or deep for a local block, but general anesthesia may not be desirable.  With local and spinal anesthesia, the surgical site is anesthetized, but the person can remain conscious or minimally sedated.  In contrast, general anesthesia may render the person unconscious and paralyzed during surgery.  The person is typically [[intubation|intubated]] to protect their airway and placed on a [[mechanical ventilator]], and anesthesia is produced by a combination of injected and inhaled agents.  The choice of surgical method and [[anesthesia|anesthetic]] technique aims to solve the indicated problem, minimize the risk of complications, optimize the time needed for recovery, and limit the [[surgical stress]] response.

===Intraoperative phase===
The intraoperative phase begins when the surgery subject is received in the surgical area (such as the [[operating theater]] or surgical [[Hospital#Departments or wards|department]]), and lasts until the subject is transferred to a recovery area (such as a [[post-anesthesia care unit]]).<ref>[https://books.google.com/books?id=Qogt_LvTi-sC&pg=PA2 Page 2] in: {{cite book | vauthors = Spry C | title=Essentials of perioperative nursing | publisher=Jones and Bartlett Publishers | location=Sudbury, Mass | year=2009 | isbn=978-0-7637-5881-3 | oclc=227920274 }}</ref>

An incision is made to access the surgical site.  [[Blood vessel]]s may be clamped or [[Cauterization|cauterized]] to prevent bleeding, and retractors may be used to expose the site or keep the incision open.  The approach to the surgical site may involve several layers of incision and dissection, as in abdominal surgery, where the incision must traverse skin, subcutaneous tissue, three layers of muscle and then the peritoneum.  In certain cases, [[bone]] may be cut to further access the interior of the body; for example, cutting the [[human skull|skull]] for [[brain]] surgery or cutting the [[Human sternum|sternum]] for [[Thoracic surgery|thoracic (chest) surgery]] to open up the [[rib cage]]. Whilst in surgery [[Asepsis|aseptic technique]] is used to prevent infection or further spreading of the disease. The surgeons' and assistants' hands, wrists and forearms are washed thoroughly for at least 4 minutes to prevent germs getting into the operative field, then sterile gloves are placed onto their hands. An antiseptic solution is applied to the area of the person's body that will be operated on. Sterile drapes are placed around the operative site. Surgical masks are worn by the surgical team to avoid germs on droplets of liquid from their mouths and noses from contaminating the operative site.{{citation needed|date=May 2023}}

Work to correct the problem in body then proceeds.  This work may involve:
{{anchor|excision}}
* excision – cutting out an organ, tumor,<ref>Wagman LD. [http://www.cancernetwork.com/cancer-management-11/chapter01/article/10165/1399286 "Principles of Surgical Oncology"] {{webarchive|url=https://web.archive.org/web/20090515031925/http://www.cancernetwork.com/cancer-management-11/chapter01/article/10165/1399286 |date=15 May 2009 }} in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) [http://www.cancernetwork.com/cancer-management-11/ Cancer Management: A Multidisciplinary Approach] {{webarchive|url=https://web.archive.org/web/20131004224102/http://www.cancernetwork.com/cancer-management-11/ |date=4 October 2013 }}. 11 ed. 2008.</ref> or other tissue.
* [[Segmental resection|resection]] – partial removal of an organ or other bodily structure.<ref>{{Cite journal |last1=Küçükkartallar |first1=Tevfik |last2=Gündeş |first2=Ebubekir |last3=Yılmaz |first3=Hüseyin |last4=Aksoy |first4=Faruk |date=2013-03-01 |title=A case of multiorgan resection for locally advanced stomach cancer |journal=Turkish Journal of Surgery/Ulusal Cerrahi Dergisi |volume=29 |issue=1 |pages=31–32 |doi=10.5152/UCD.2013.07 |issn=1300-0705 |pmc=4379777 |pmid=25931839}}</ref>
* reconnection of organs, tissues, etc., particularly if severed.  Resection of organs such as intestines involves reconnection.  Internal [[surgical suture|suturing]] or stapling may be used.  Surgical connection between blood vessels or other tubular or hollow structures such as loops of intestine is called [[anastomosis]].<ref>{{Cite web |title=magnetic compression anastomosis: Topics by Science.gov |url=https://www.science.gov/topicpages/m/magnetic+compression+anastomosis |access-date=2022-10-30 |website=www.science.gov}}</ref>
* reduction – the movement or realignment of a body part to its normal position.  e.g. Reduction of a broken nose involves the physical manipulation of the bone or cartilage from their displaced state back to their original position to restore normal airflow and aesthetics.<ref>{{Citation |last1=Alvi |first1=Sirhan |title=Nasal Fracture Reduction |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK538299/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30855883 |access-date=2022-10-30 |last2=Patel |first2=Bhupendra C.}}</ref>
* [[Ligature (medicine)|ligation]] – tying off blood vessels, ducts, or "tubes".<ref>{{Citation |last1=Sung |first1=Sharon |title=Tubal Ligation |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK549873/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=31751063 |access-date=2022-10-30 |last2=Abramovitz |first2=Aaron}}</ref>
* [[Medical grafting|grafts]] – may be severed pieces of tissue cut from the same (or different) body or flaps of tissue still partly connected to the body but resewn for rearranging or restructuring of the area of the body in question.  Although grafting is often used in cosmetic surgery, it is also used in other surgery.  Grafts may be taken from one area of the person's body and inserted to another area of the body.  An example is [[Vascular bypass|bypass surgery]], where clogged blood vessels are bypassed with a graft from another part of the body.  Alternatively, grafts may be from other persons, cadavers, or animals.<ref>{{Citation |last1=Prohaska |first1=Joseph |title=Skin Grafting |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK532874/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30422469 |access-date=2022-10-30 |last2=Cook |first2=Christopher}}</ref>
* insertion of [[Prosthesis|prosthetic]] parts when needed.  Pins or screws to set and hold bones may be used.  Sections of bone may be replaced with prosthetic rods or other parts.  Sometimes a plate is inserted to replace a damaged area of skull.  [[Artificial hip]] replacement has become more common.<ref>{{Citation |last1=Bori |first1=Edoardo |title=Hip prosthesis: biomechanics and design |date=2022 |url=https://www.sciencedirect.com/topics/engineering/hip-prosthesis |work=Human Orthopaedic Biomechanics |pages=361–376 |publisher=Elsevier |language=en |doi=10.1016/B978-0-12-824481-4.00032-9 |access-date=2022-10-30 |last2=Galbusera |first2=Fabio |last3=Innocenti |first3=Bernardo|isbn=978-0-12-824481-4 |url-access=subscription }}</ref>  [[Heart pacemaker]]s or [[Heart valve|valves]] may be inserted.  Many other types of [[Prosthesis|prostheses]] are used.
* creation of a [[stoma (medicine)|stoma]], a permanent or semi-permanent opening in the body<ref>{{Cite journal |last1=Whitehead |first1=Alia |last2=Cataldo |first2=Peter |date=2017-05-22 |title=Technical Considerations in Stoma Creation |journal=Clinics in Colon and Rectal Surgery |language=en |volume=30 |issue=3 |pages=162–171 |doi=10.1055/s-0037-1598156 |pmid=28684933 |pmc=5498162 |issn=1531-0043}}</ref>
* in [[Organ transplant|transplant]] surgery, the donor organ (taken out of the donor's body) is inserted into the recipient's body and reconnected to the recipient in all necessary ways (blood vessels, ducts, etc.).<ref>{{Cite journal |last=Zalewska |first=Kathy |title=National Standards for Organ Retrieval from Deceased Donors |url=https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/12548/mpd1043-nors-standard.pdf |journal=NHS Blood and Transplant |access-date=30 October 2022 |archive-date=17 October 2022 |archive-url=https://web.archive.org/web/20221017160645/http://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/12548/mpd1043-nors-standard.pdf |url-status=dead }}</ref>
* [[arthrodesis]] – surgical connection of adjacent bones so the bones can grow together into one. [[Spinal fusion]] is an example of adjacent [[vertebrae]] connected allowing them to grow together into one piece.<ref>{{Cite journal |last=Nouh |first=Mohamed Ragab |date=2012 |title=Spinal fusion-hardware construct: Basic concepts and imaging review |journal=World Journal of Radiology |language=en |volume=4 |issue=5 |pages=193–207 |doi=10.4329/wjr.v4.i5.193 |doi-broken-date=3 March 2025 |pmid=22761979 |pmc=3386531 |issn=1949-8470 |doi-access=free }}</ref>
* modifying the [[digestive tract]] in [[bariatric surgery]] for [[weight loss]].
* repair of a [[fistula]], [[hernia]], or [[prolapse]].
* repair according to the [[ICD-10-PCS]], in the Medical and Surgical Section 0, root operation Q, means restoring, to the extent possible, a body part to its normal anatomic structure and function. This definition, repair, is used only when the method used to accomplish the repair is not one of the other root operations. Examples would be [[colostomy]] takedown, [[herniorrhaphy]] of a [[hernia]], and the [[surgical suture]] of a [[laceration]].<ref>{{Cite journal |last1=Gillern |first1=Suzanne |last2=Bleier |first2=Joshua I. S. |date=2014 |title=Parastomal Hernia Repair and Reinforcement: The Role of Biologic and Synthetic Materials |journal=Clinics in Colon and Rectal Surgery |volume=27 |issue=4 |pages=162–171 |doi=10.1055/s-0034-1394090 |issn=1531-0043 |pmc=4226750 |pmid=25435825}}</ref>
* other procedures, including:
:*clearing clogged ducts, blood or other vessels
:*removal of calculi (stones)
:*draining of accumulated fluids
:*[[debridement]] – removal of dead, damaged, or diseased tissue
[[Blood transfusion|Blood]] or blood expanders may be administered to compensate for blood lost during surgery.  Once the procedure is complete, [[surgical suture|sutures]] or [[Surgical staple|staples]] are used to close the incision.  Once the incision is closed, the anesthetic agents are stopped or reversed, and the person is taken off ventilation and [[wikt:extubate|extubated]] (if general anesthesia was administered).<ref name="books.google.com">Askitopoulou, H., Konsolaki, E., Ramoutsaki, I., Anastassaki, E. ''Surgical cures by sleep induction as the Asclepieion of Epidaurus.'' The history of anesthesia: proceedings of the Fifth International Symposium, by José Carlos Diz, Avelino Franco, Douglas R. Bacon, J. Rupreht, Julián Alvarez. Elsevier Science B.V., International Congress Series 1242(2002), pp.&nbsp;11–17. [https://books.google.com/books?id=TM-8NIDPowoC&q=History+of+Hospital%2BAsclepieion&pg=PA11]{{Dead link|date=May 2023|bot=InternetArchiveBot|fix-attempted=yes}}</ref>

===Postoperative care===
After completion of surgery, the person is transferred to the [[post anesthesia care unit]] and closely monitored.  When the person is judged to have recovered from the anesthesia, he/she is either transferred to a surgical ward elsewhere in the hospital or discharged home.  During the post-operative period, the person's general function is assessed, the outcome of the procedure is assessed, and the surgical site is checked for signs of infection. There are several risk factors associated with postoperative complications, such as immune deficiency and obesity. Obesity has long been considered a risk factor for adverse post-surgical outcomes. It has been linked to many disorders such as obesity [[hypoventilation]] syndrome, [[atelectasis]] and pulmonary embolism, adverse cardiovascular effects, and wound healing complications.<ref>{{cite journal | vauthors = Doyle SL, Lysaght J, Reynolds JV | title = Obesity and post-operative complications in patients undergoing non-bariatric surgery | journal = Obesity Reviews | volume = 11 | issue = 12 | pages = 875–886 | date = December 2010 | pmid = 20025695 | doi = 10.1111/j.1467-789X.2009.00700.x | s2cid = 7712323 }}</ref> If removable skin closures are used, they are removed after 7 to 10 days post-operatively, or after healing of the incision is well under way.{{citation needed|date=May 2023}}

It is not uncommon for [[Drain (surgery)|surgical drains]] to be required to remove blood or fluid from the surgical wound during recovery. Mostly these drains stay in until the volume tapers off, then they are removed. These drains can become clogged, leading to [[abscess]].<ref>{{Cite web|vauthors=Pastorino A, Tavarez MM|title=Incision and drainage|date=24 July 2023|publisher=StatPearls Publishing|pmid=32310532 |url=https://www.ncbi.nlm.nih.gov/books/NBK556072/|accessdate=11 March 2024}}</ref>

Postoperative therapy may include [[adjuvant]] treatment such as [[chemotherapy]], [[radiation therapy]], or administration of [[medication]] such as [[anti-rejection medication]] for transplants. For postoperative nausea and vomiting (PONV), solutions like saline, water, controlled breathing placebo and aromatherapy can be used in addition to medication.<ref>{{cite journal | vauthors = Hines S, Steels E, Chang A, Gibbons K | title = Aromatherapy for treatment of postoperative nausea and vomiting | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 3 | pages = CD007598 | date = March 2018 | pmid = 29523018 | pmc = 6494172 | doi = 10.1002/14651858.CD007598.pub3 }}</ref> Other follow-up studies or [[Physical therapy|rehabilitation]] may be prescribed during and after the recovery period. A recent post-operative care philosophy has been early ambulation. Ambulation is getting the patient moving around. This can be as simple as sitting up or even walking around. The goal is to get the patient moving as early as possible. It has been found to shorten the patient's length of stay. Length of stay is the amount of time a patient spends in the hospital after surgery before they are discharged. In a recent study<ref>{{cite journal | vauthors = Huang J, Shi Z, Duan FF, Fan MX, Yan S, Wei Y, Han B, Lu XM, Tian W | title = Benefits of Early Ambulation in Elderly Patients Undergoing Lumbar Decompression and Fusion Surgery: A Prospective Cohort Study | journal = Orthopaedic Surgery | volume = 13 | issue = 4 | pages = 1319–1326 | date = June 2021 | pmid = 33960687 | pmc = 8274205 | doi = 10.1111/os.12953 }}</ref> done with lumbar decompressions, the patient's length of stay was decreased by 1–3 days.

The use of [[Antibacterial|topical antibiotics]] on surgical wounds to reduce infection rates has been questioned.<ref name="AADfive">{{Citation |author1 = American Academy of Dermatology |author1-link = American Academy of Dermatology |date = February 2013 |title = Five Things Physicians and Patients Should Question |publisher = [[American Academy of Dermatology]] |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-dermatology/ |access-date = 5 December 2013 |url-status=live |archive-url = https://web.archive.org/web/20131201171621/http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-dermatology/ |archive-date = 1 December 2013 }}, which cites
* {{cite journal | vauthors = Sheth VM, Weitzul S | title = Postoperative topical antimicrobial use | journal = Dermatitis | volume = 19 | issue = 4 | pages = 181–189 | year = 2008 | pmid = 18674453 | doi = 10.2310/6620.2008.07094 }}</ref> Antibiotic ointments are likely to irritate the skin, slow healing, and could increase risk of developing [[contact dermatitis]] and [[antibiotic resistance]].<ref name="AADfive"/> It has also been suggested that topical antibiotics should only be used when a person shows signs of infection and not as a preventative.<ref name="AADfive"/> A systematic review published by [[Cochrane (organisation)]] in 2016, though, concluded that topical antibiotics applied over certain types of surgical wounds reduce the risk of surgical site infections, when compared to no treatment or use of [[antiseptic]]s.<ref>{{cite journal | vauthors = Heal CF, Banks JL, Lepper PD, Kontopantelis E, van Driel ML | title = Topical antibiotics for preventing surgical site infection in wounds healing by primary intention | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 11 | pages = CD011426 | date = November 2016 | pmid = 27819748 | pmc = 6465080 | doi = 10.1002/14651858.cd011426.pub2 | url = http://espace.library.uq.edu.au/view/UQ:413965/UQ413965_OA.pdf | archive-url = https://web.archive.org/web/20180723044104/https://espace.library.uq.edu.au/data/UQ_413965/UQ413965_OA.pdf?Expires=1532371516&Signature=Ga9lfd5ycgb~3Rlr6lSj4JcYzJOD6h9bENz7GeJxXLNvKB3KEDh3tRf90xQlPyB2yfMVoqOUelfouffZI0jt0TVWtXN9N9RC6CoJfI7LevaXtxnuWQmz~wcsDRjBZynlpjUa3uo44kv6ak6IVlKLFQ6QMXRs2J-6cf1J8jEx31QUOrISujNEWq1aSkR7IwkURK7x5MprcFoGfwaiqD74YZ64hLTWaQai-Zhd435OetLwPYT-tu3aOY5~Fe2egUuK2ubtVVQhaAS-mt5bMGaj59z3gcdQo6vTfEATZ~a3wlQzUXyEZPPQC6DCuYYiUU7nO6WocS2AwswNxH7edl1gJQ__&Key-Pair-Id=APKAJKNBJ4MJBJNC6NLQ | archive-date = 23 July 2018 }} [http://man.ac.uk/a7GkYb Alt URL]</ref> The review also did not find conclusive evidence to suggest that topical antibiotics increased the risk of local skin reactions or antibiotic resistance.{{citation needed|date=May 2023}}

Through a retrospective analysis of national administrative data, the association between mortality and day of elective surgical procedure suggests a higher risk in procedures carried out later in the working week and on weekends. The odds of death were 44% and 82% higher respectively when comparing procedures on a Friday to a weekend procedure. This "weekday effect" has been postulated to be from several factors including poorer availability of services on a weekend, and also, decrease number and level of experience over a weekend.<ref>{{cite journal | vauthors = Aylin P, Alexandrescu R, Jen MH, Mayer EK, Bottle A | title = Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics | journal = BMJ | volume = 346 | pages = f2424 | date = May 2013 | pmid = 23716356 | pmc = 3665889 | doi = 10.1136/bmj.f2424 }}</ref>

Postoperative pain affects an estimated 80% of people who underwent surgery.<ref name=":0">{{cite journal | vauthors = Doleman B, Leonardi-Bee J, Heinink TP, Bhattacharjee D, Lund JN, Williams JP | title = Pre-emptive and preventive opioids for postoperative pain in adults undergoing all types of surgery | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 12 | pages = CD012624 | date = December 2018 | pmid = 30521692 | pmc = 6517298 | doi = 10.1002/14651858.CD012624.pub2 }}</ref> While pain is expected after surgery, there is growing evidence that pain may be inadequately treated in many people in the acute period immediately after surgery. It has been reported that incidence of inadequately controlled pain after surgery ranged from 25.1% to 78.4% across all surgical disciplines.<ref>{{cite journal | vauthors = Yang MM, Hartley RL, Leung AA, Ronksley PE, Jetté N, Casha S, Riva-Cambrin J | title = Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis | journal = BMJ Open | volume = 9 | issue = 4 | pages = e025091 | date = April 2019 | pmid = 30940757 | pmc = 6500309 | doi = 10.1136/bmjopen-2018-025091 }}</ref> There is insufficient evidence to determine if giving opioid pain medication pre-emptively (before surgery) reduces postoperative pain the amount of medication needed after surgery.<ref name=":0" />

Postoperative recovery has been defined as an energy‐requiring process to decrease physical symptoms, reach a level of emotional well‐being, regain functions, and re‐establish activities.<ref>{{cite journal | vauthors = Allvin R, Berg K, Idvall E, Nilsson U | title = Postoperative recovery: a concept analysis | journal = Journal of Advanced Nursing | volume = 57 | issue = 5 | pages = 552–558 | date = March 2007 | pmid = 17284272 | doi = 10.1111/j.1365-2648.2006.04156.x }}</ref> Most people are discharged from the hospital or surgical center before they are fully recovered.  The recovery process may include complications such as [[postoperative cognitive dysfunction]] and [[postoperative depression]].<ref>{{Cite journal |last1=Lin |first1=Xianyi |last2=Chen |first2=Yeru |last3=Zhang |first3=Piao |last4=Chen |first4=Gang |last5=Zhou |first5=Youfa |last6=Yu |first6=Xin |date=February 2020 |title=The potential mechanism of postoperative cognitive dysfunction in older people |url=https://pubmed.ncbi.nlm.nih.gov/31765741 |journal=Experimental Gerontology |volume=130 |pages=110791 |doi=10.1016/j.exger.2019.110791 |issn=1873-6815 |pmid=31765741|doi-access=free }}</ref><ref>{{Cite journal |last1=Ghoneim |first1=Mohamed M. |last2=O'Hara |first2=Michael W. |date=2016-02-02 |title=Depression and postoperative complications: an overview |journal=BMC Surgery |volume=16 |pages=5 |doi=10.1186/s12893-016-0120-y |doi-access=free |issn=1471-2482 |pmc=4736276 |pmid=26830195}}</ref>