Postoperative care Study Guide

📖 Core Concepts Surgery – Medical specialty using manual/instrumental techniques to diagnose or treat trauma, disease, injury, or malignancy. Invasiveness – All surgeries breach the body; “non‑invasive” actually means minimally invasive (tiny incisions, natural orifices, or radiosurgery). Surgical Team – Surgeon (primary operator) + assistant, anesthetist, anesthesia nurse, scrub nurse, circulating nurse, technologist. Classification by Timing – Elective (planned, non‑urgent), Semi‑elective (early but can wait short time), Emergency (cannot delay). Classification by Purpose – Therapeutic, Curative, Curative, Reconstructive, Cosmetic, Bariatric, Exploratory, etc. Classification by Procedure Type – Ablation, Resection, Grafting, Bypass, Implantation, Repair, Transplant, etc. Pre‑operative Testing Goal – Detect hidden conditions that would alter anesthesia safety or surgical plan; should be targeted, not routine. Post‑operative Recovery – Multi‑dimensional: physical symptom reduction, emotional well‑being, functional ability, return to daily activities. --- 📌 Must Remember Suffixes – ‑ectomy (removal), ‑otomy (incision), ‑oscopy (endoscopic), ‑ostomy (permanent opening), ‑plasty (reconstruction), ‑orrhaphy (repair), ‑myotomy (muscle cut). ASA Physical Status – Primary pre‑op risk stratifier (I–VI). Bellwether procedures – Laparotomy, Caesarean section, Open fracture care → benchmark for first‑level hospital capability. Frailty Scale (5 items) – Weight loss, weak grip, exhaustion, low activity, slow walking; scores 0‑5 predict postoperative risk. Routine pre‑op testing – NOT indicated for low‑risk elective surgery per NICE & ASA; order only if result changes management. Post‑op pain prevalence – 80 % of surgical patients experience it; risk ↑ with younger age, female sex, smoking, pre‑op pain, depression/anxiety, obesity, opioid use pre‑op. Early ambulation – Reduces length of stay & complications (e.g., DVT, pulmonary embolism). --- 🔄 Key Processes Pre‑operative Evaluation Obtain history & focused physical → assess ASA status. Determine need for labs/radiography: Will result change plan? → order if yes. Bowel prep & NPO after midnight for GI procedures. Intra‑operative Workflow Incision → exposure (retractors, clamps). Layered dissection (skin → subcutaneous → muscle layers → peritoneum). Core tasks: Anastomosis, Ligation, Reduction, Prosthetic insertion, Stoma creation, Arthrodesis. Hemostasis → closure (sutures/staples) → reverse anesthesia & extubate. Post‑operative Care Path PACU monitoring → transfer to ward or discharge. Inspect wound, manage drains, control pain, encourage ambulation. Remove skin staples/sutures 7‑10 days; remove drains when output ↓. --- 🔍 Key Comparisons Elective vs. Emergency Surgery Elective: planned, non‑life‑threatening; can be scheduled. Emergency: unavoidable delay → death, disability, limb loss. Open vs. Minimally Invasive Surgery Open: large incision, direct view, higher postoperative pain & infection risk. Minimally invasive: small ports or natural orifice, less pain, faster recovery, may need specialized equipment. Curative vs. Palliative (Therapeutic) Surgery Curative: permanently removes pathology → cure. Therapeutic: relieves symptoms but may not eradicate disease. --- ⚠️ Common Misunderstandings “Non‑invasive surgery” exists – Actually minimally invasive; still breaches tissue. All pre‑op labs are mandatory – Over‑testing adds cost, false positives, delays; only test if it will change management. All postoperative pain is opioid‑responsive – Opioid pre‑emptive analgesia lacks strong evidence; multimodal analgesia is preferred. Surgical suffix “‑plasty” always cosmetic – It denotes reconstruction (functional or aesthetic). --- 🧠 Mental Models / Intuition “Invasion = Access + Exposure + Repair” – Any surgery can be broken down into gaining access, exposing the target, then repairing/removing. “ASA → Risk Ladder” – Higher ASA class = higher peri‑operative complication probability; use as quick triage. “Frailty = 5‑point score → Multiply risk” – Each point roughly doubles complication risk; treat frailty like a dose‑response curve. --- 🚩 Exceptions & Edge Cases Patients >65 y or with CV risk → Even “minor” surgeries may need ECG & chest X‑ray. Bariatric procedures – Create intentional malabsorption; not just weight loss. Hybrid surgery – Combines open + minimally invasive steps; may need larger “hand ports.” Routine chest X‑ray – Not recommended for healthy adults; only indicated with pulmonary risk factors. --- 📍 When to Use Which Choose anesthesia type – Local: small, peripheral procedures. Regional (spinal/epidural): lower limb/abdomen, reduces systemic effects. General: lengthy, intra‑abdominal, airway compromise risk. Select surgical approach – Open: need tactile feedback, large tumor, vascular control, or unavailable minimally invasive tech. Minimally invasive: patient prefers quicker recovery, low‑to‑moderate complexity, equipment available. Order pre‑op tests – Yes → abnormal history, high ASA, anticipated major blood loss, age >65, comorbidities. No → low‑risk elective surgery, normal exam, no red‑flag history. --- 👀 Patterns to Recognize “‑ectomy, ‑otomy, ‑plasty” patterns in operative notes → instantly infer removal, incision, reconstruction. Post‑op pain spikes → often correlate with opioid‑naïve patients or pre‑op chronic pain. Delayed wound healing → look for obesity, smoking, diabetes, immunosuppression. Repeated “re‑” prefix (reoperation, revision) → anticipate higher complication risk. --- 🗂️ Exam Traps Distractor: “All surgeries require pre‑op chest X‑ray” – Wrong; only indicated with specific risk factors. Distractor: “Non‑invasive surgery = no incision” – Misleading; term is a misnomer. Distractor: “‑plasty always cosmetic” – Confuses reconstructive vs. aesthetic; many ‑plasty procedures are functional (e.g., rhinoplasty for airway). Distractor: “Routine labs improve outcomes for any surgery” – Evidence shows no benefit for low‑risk cases; may cause harm. Distractor: “Pre‑emptive opioids guarantee less post‑op pain” – Current evidence is insufficient; multimodal analgesia is preferred. ---