An Overview of Surgery

Empty Operation Room In Hospital
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Surgery is medical treatment provided through an opening in the body. Traditionally, this meant making a large incision to perform the procedure, but advances in technology allow for making a few small (less than 1 centimeter) incisions and using tiny tools and cameras. 

The purpose of surgery varies, but it may be recommended for making or confirming a diagnosis, removing damaged tissue or an obstruction, repairing or repositioning tissues or organs, implanting devices, redirecting blood vessels, or transplanting tissues or organs. Some people opt for surgery for cosmetic reasons. 

Learning that you need surgery can be a confusing and intimidating prospect, and you may have many questions. It can be helpful to understand basic surgical terminology.

More than one million Americans have a successful surgical procedure each week, according to the National Quality Forum. While planning to have surgery can be stressful, it is usually a step toward better health and wellness.

Common Surgical Terms

There are many terms that your doctor may use to describe surgery.

Some relate to what prompts the surgery:

  • Elective surgery: This is a surgery that you either plan to have for treatment (e.g., a lumpectomy), improvement of quality of life (e.g., a knee replacement), or for cosmetic purposes (e.g., a rhinoplasty).
  • Emergency surgery: This is a surgery that is done in order to treat an urgent medical need (e.g., appendectomy).

Others pertain to where the procedure will be performed:

  • Inpatient surgery: This is a procedure performed in the hospital with the expectation that the patient will stay overnight for at least one day.
  • Outpatient or same-day surgery: The procedure is performed in a hospital or surgery center with the expectation that the patient will go home after waking completely from anesthesia. This is also sometimes called ambulatory surgery.

Of course, there are myriad more. If you hear a term you are unfamiliar with or confused by, ask your doctor to clarify it for you.

Types and Phases of Surgery

The way in which a procedure is performed can minimize related risks and impact recovery time. Depending on what you are having done, your doctor may perform:

  • Open or traditional surgery: The traditional approach of using a single, full-length incision to perform a procedure.
  • Minimally invasive (laparoscopic) surgery: In contrast to the one long incision used in open surgery, this newer surgical technique involves several small incisions. This type of surgery usually requires a shorter recovery period than the same procedure using a large incision.
  • Robotic surgery: A robot is used to perform surgery, with a surgeon guiding the robot’s steady “hands.” This technique is used most frequently when tiny, undesired movements can change the outcome of the procedure.

Surgery is often broken down into phases that help group the tasks that need to be completed at a given time. There are three primary phases, which are described in greater detail below, are:

  • Preoperative, or pre-op, is the phase that starts with scheduling surgery and lasts until the procedure.
  • The operative phase is the procedure itself, from entering the operating room until leaving.
  • The postoperative, or post-op, phase begins when the surgery is completed and the recovery begins.

The term perioperative refers to the entire surgery experience and includes all three phases.

Deciding on Surgery

Surgery is not a decision to take lightly. With the exception of emergency surgery, most people have time to research the procedure and potential surgeons before committing. All surgeries come with risks, so it is important to talk this through with a physician before making a decision.

The first step is finding a surgeon. Ask around for recommendations. Your doctor will likely give you some suggestions, but it is also helpful to ask for recommendations from friends and loved ones. Once you have a list of names, check to confirm they are in your insurance plan, then research the doctor's reputation and credentials.

Narrow the list down to two or three potential surgeons and make an appointment for a consultation and a second opinion. Talking to two surgeons can help solidify your decision to have the surgery, but it can also help you explore alternative options. Medicare, Medicaid, and most insurance plans will pay for a second opinion.

Make a list of questions you have and bring them to your appointment. Your doctor should be able to answer questions you have about your condition, offer possible treatments, and detail any recommended procedures.

Declining Surgery

If, in the end, you decide that surgery is not right for you, saying "no" is absolutely appropriate. There are times when a procedure may have benefits, but a patient is unwilling to undergo surgery for their own reasons. Making this choice is your right.

While it may lead to disagreements with family and friends, the decision belongs to you. If you go this route, just be sure that you are fully informed about (and willing to accept) any risks your decision may pose to your health.

For others, taking a less invasive approach may be preferred. Many patients view surgery as a last resort, rather than their first choice in treatments. For these patients, physical therapy, medication, lifestyle changes, and other types of interventions may be preferable.

Preop: Before Surgery

The preop period includes the time between scheduling the procedure (if elective) and being wheeled into the operating room. This time is your best opportunity to plan and prepare to have the best possible outcome from your surgery.

The office will provide information about where the surgery will be done and what to expect afterward. The exact time of your scheduled surgery and when you need to check-in is typically determined a day or two before the procedure.

Medical Clearance and Consult

When you schedule your surgery, your doctor's office will inform you of the next steps. These typically include a planning appointment or phone call with the anesthesia provider, who will go over your health history and discuss the type of anesthesia you'll receive and the risks involved.

Your doctor will give you a preop check-up to ensure you are healthy for surgery. This is typically done within a month before the surgery and gives the physician time to treat any other conditions you may have. Your doctor may refer you to another specialist such as a cardiologist if you have a history of heart disease, an endocrinologist if you have diabetes, or a hematologist if you have a history of blood clots.

Common tests your doctor may order include blood work, chest X-ray, electrocardiogram (ECG), a colonoscopy or upper endoscopy, heart stress test, lung function tests, and imaging, such as MRI, CT scan, or ultrasound. Make sure these test results and reports are also sent to your surgeon. 

Physical Preparation

Aside from choosing the right surgeon, preparing physically may be the most important thing a surgery patient can do to impact how successful the surgery is and how quickly the recovery phase ends.

This means optimizing one’s health in every possible way. From quitting smoking to doing routine exercise and improving control of diabetes, going into surgery as healthy as possible can mean shorter hospital stays, better long-term success, and a faster return to routine activity.

Your doctor's office will provide instructions for the days leading up to the surgery.

Be sure to follow all of your doctor's preop instructions. This may include stopping prescription medications, avoiding certain over the counter drugs prior to surgery, not eating or drinking in the hours before surgery, and bathing according to directions.

Ask any questions you may have and follow any directions you are given.

Emotional Preparation

For some, the thought of surgery can be daunting and overwhelming. You may need help overcoming this so you feel comfortable going into your procedure. Talk to your healthcare team about any concerns you have.

If you are dealing with a lot of anxiety over the procedure, your doctor may prescribe anti-anxiety medication to take the night before surgery. In addition, some people find talking with a therapist before surgery can help them process the upcoming procedure and develop a plan for staying calm.

Children often need help preparing for surgery in a way that does not lead to fear and anxiety, and that is appropriate for their age and ability to understand health information.

To help with this, most hospitals have mental health professionals who can meet with you or your child before surgery, if needed.

Planning for Costs

Preparing financially for your procedure in advance can save you surprise costs later. This includes checking with your insurance company to confirm services and providers are covered and also making plans for taking leave from work. Check with your human resources department to find out if you will be paid during your leave or if you need to file a temporary disability claim.

Talk to the hospital or surgical center's billing department to determine the expected cost of the procedure, making sure to ask about any hidden costs that may not be included in the initial bill—such as anesthesia. You may need to talk to individual departments to determine the full cost.

Your insurance may pay a higher percentage of the bill at one facility and less at another; don’t hesitate to call your insurance provider and inquire about percentage rates of coverage.

If you do not have insurance, you will need to work closely with the hospital and surgeon to make financial arrangements.

Planning for Recovery

The preop phase is also the time to prepare for the return home from surgery. This may not be much of a concern if you are having a minor outpatient procedure, but it will be if you need to spend several days in the hospital, will need help with everyday tasks once you're released, and so on. Your planning will be unique to your needs.

For some, it means finding a dog sitter; for others who have lifting restrictions, it will mean finding someone to help them carry things; someone with a driving restriction will need help running errands.

Depending on the surgery, you may require a brief stay at a rehabilitation facility or visiting nurse or home healthcare aide for a period after your surgery. Ask your surgeon if they anticipate you will need additional care after discharge, and if so, check with your insurance company about coverage.

Operative: During Surgery

This part of the surgery is about anesthesia and the actual surgical procedure. This phase begins when you enter the operating room and ends when the procedure is finished and anesthesia is stopped.

Your planning will pay off in the operative phase when the surgeon who is an expert in providing the care you need and the anesthesia provider who understands your unique needs perform your procedure.

Postop: After Surgery

This phase begins when your procedure ends. You will be moved to the area of the facility where you will recover from surgery. This phase continues until you have recovered as much as possible from surgery.

For some, that means going home and taking a nap; for others, rehabilitation in the form of physical therapy and occupational therapy, or something similar, may be needed.

Pain Management

While pain is often present after surgery, there are many ways to deal with, prevent, and treat pain that can dramatically improve your experience.

Surgical pain is typically managed by the surgeon, who will provide prescriptions (if necessary) and recommendations for pain relief when you are being discharged.

Adequate pain relief is important for preventing pneumonia, a common complication after surgery in patients who avoid coughing due to pain. There are other common issues after surgery, such as constipation, most of which can be avoided with other strategies.

Recovery Plans

Know where you plan to recover. For some, a stay at a rehabilitation facility is planned; for others, resting at a loved one’s home for a few days is all the help they need. Knowing how long your recovery will take and where it is likely to take place will help with anticipating the assistance that will be required.

The goal after surgery is typically to return to the same function you had prior to surgery, or even better function. An individual who avoided walking due to pain may find themselves taking long walks after recovering from knee replacement surgery, and cataract surgery patients may find themselves reading more books.

While you may be eager for such milestones, remember that reaching them can take time. Follow your doctor's instructions for resuming old and trying new activities.

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Article Sources

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  1. American Society of Colon and Rectal Surgeons. Laparoscopic Surgery - What is it?

  2. Medicare.gov Getting a second opinion before surgery. Updated April 2018.

  3. American Society of Anesthesiologists. Preparing for surgery: Checklist.

  4. U.S. National Library of Medicine: MedlinePlus. Tests and Visits Before Surgery.

  5. Cleveland Clinic. Pain control after surgery.

Additional Reading