Surgery is the specialty of medicine that treats diseases and disorders by cutting, removing or changing the body with an operative procedure.
Topics covered in this snack-sized chapter:
The branch of medicine concerned with the treatment of disease, injury, and deformity by physical operation or manipulation.
Surgery is performed by a surgeon, a physician with specialized training in operative procedures.
Surgeries can be minor outpatient procedures or major procedures such as a heart transplant.
An outpatient surgery is a procedure where the patient reports for surgery early in the morning and is expected to return home that day for recovery. Outpatient surgeries are typically minor surgeries that have a low risk of complications.
Surgery involves cutting into the skin or other organs to accomplish any of the following goals:
- Further explore the condition for diagnosis.
- Take a biopsy of a suspicious lump.
- Remove diseased tissues or organs.
- Reposition structures to their normal position.
- Transplant tissue or whole organs
- Implant mechanical or electronic devices.
There are four basic aims and objectives underpinning surgical education:
- Improve physical appearance.
- Good communication skills
- Proficient technical skills
Following points have had a major impact on both surgical practice and surgical education:
- Excellent clinical judgment
- Rapidly developing and emerging technologies.
- Unprecedented scientific advances.
- Significant changes in societal expectations.
- Intense focus on physician competence.
Surgery can be classified depending on:
- Concerns regarding patient safety.
- The seriousness of the illness.
- The parts of the body affected.
- The complexity of the operation.
The types of surgery are as follows:
- The expected recovery time.
A major surgery is any surgery in which the patient must be put under general anesthesia and given respiratory assistance because he or she cannot breathe independently.
Major surgery usually carries some degree of risk to the patient's life, or the potential for severe disability if something goes wrong during the surgery.
In a major surgical procedure, significant resection or changes to the anatomy are involved, as in situations where organs are removed, or joints are rebuilt with artificial parts.
Neurosurgery is generally considered as major surgery because of the risks to the patient.
Minor surgery is any surgical procedure that does not involve anesthesia or respiratory assistance during the surgical procedure.
The recovery time is short and patient return to their usual activities rapidly.
These surgeries are most often done as an outpatient, and the patient can return home the same day.
Complications from these types of surgeries are rare.
Example: removal of skin lesions.
Elective surgery is non-emergency surgery which is planned, allowing the patient and doctor to determine the best time and place for it.
There are a wide range of procedures which could be considered elective.
Example: Hernia repair.
These are the procedures that need to be done to ensure the quality of patient’s life in the future.
Required surgery, unlike emergency surgery, does not necessarily have to be done immediately and can allow time to prepare oneself for the experience.
Examples: Cataract, spinal fusion, sinus operation.
A surgical procedure that cannot be delayed, i.e.
- Urgent or Emergency Surgery
- For which there is no alternative therapy or surgeon, and
Examples: Open fracture of skull, extensive burns, urinary obstruction.
The surgical team is a unit providing the continuum of care beginning with preoperative care, and extending during the surgery procedures, and postoperative recovery.
When a patient undergoes surgery, a team of medical staff assists the surgeon in the procedure.
The number of team members differs depending on the type of surgery performed.
Most teams include the following:
- For which a delay could result in death or permanent impairment of health.
- The Certified Registered Nurse Anesthetist (CRNA).
No surgery is risk free, but understanding the possible complications can help you make a better decision.
Common surgical risks associated with surgery are:
- The Operating Room Nurse/ Circulating Nurse.
Anesthesia involves medication that induces unconsciousness and unawareness of all pain.
An anesthesiologist also inserts an endotracheal tube into the windpipe to ensure safe respiration during the surgery.
Most problems associated with anesthesia are related to the process of intubation, or inserting the breathing tube.
Aspiration, or breathing food or fluid into the lungs, can be a problem, during surgery.
Some bleeding is expected during surgery, but bleeding beyond the normal amount can make a transfusion necessary.
If bleeding is severe enough to cause a crisis, surgery may be terminated or a significant transfusion may be necessary.
A preoperative evaluation of a surgical patient includes assessment of cardiovascular risk factors.
Patients with certain heart conditions have a level of surgical risk depending on condition severity.
The cardiac risk is greater than the risk associated with the condition requiring surgery.
After the surgery, all internal and external wounds need to heal.
A gradual healing process occurs that results in fibrous scar tissue in the wound.
Some patients take longer to heal than others, particularly people with more than one illness.
There is a risk of infection any time the skin is opened.
A surgical incision creates a significant opportunity for infection to enter the body, even though surgery is done in a very clean environment.
Blood clots, often referred to as a Deep Vein Thrombosis (DVT) are a significant risk of surgery.
The clots can start in the area of surgery or be caused by inactivity during recovery.
Surgical care is complex and involves dozens of steps that must be optimized for individual patients.
In order to effectively minimize unnecessary loss of life and serious complications, operative teams have ten basic and essential objectives in any surgical case, which the WHO Safe Surgery Guidelines aim to support:
- The team will operate on the correct patient at the correct site.
- The team will use methods known to prevent harm from administration of anesthetics, while protecting the patient from pain.
- The team will recognize and effectively prepare for life threatening loss of airway or respiratory function.
- The team will recognize and effectively prepare for risk of high blood loss.
- The team will avoid inducing any allergic or adverse drug reaction for which the patient is known to be at significant risk
- The team will consistently use methods known to minimize the risk for surgical site infection.
- The team will prevent inadvertent retention of instruments and sponges in surgical wounds.
- The team will secure and accurately identify all surgical specimens.
- The team will effectively communicate and exchange critical patient information for the safe conduct of the operation.
When planning a surgery, it is important for a patient to let his surgeon know the following about himself:
- Hospitals and public health systems will establish routine surveillance of surgical capacity, volume and results.
- Previous Illness and Surgeries
- Current Health Conditions