Perioperative care

Major surgery can be a very intimidating experience. It is our task to see the patients through the process, from beginning to end, and to ease any trepidation the patient may have regarding the procedure. The surgical department is made up of a multi-professional team from physicians, anesthesiologists, surgical nurses, medical technicians, nurses, orderlies and assistants whose primary purpose is to extend to the patient dedicated and skilled care.


Pre- and intra-operative pathway

Before surgery, the medical and nursing staff will give instructions concerning the procedure. It is very important that the patient follows these directions, so the surgery or procedure may proceed as planned.

Here are some other pre-surgery instructions the patient need to follow:

  • Shower or bathe no more than 12 hours prior to surgery using an antimicrobial soap. The nursing staff will instruct the patient to use disposable wipes and a special soap, please do so according to those instructions.
  • 8-12 hours before surgery the patient should not eat or drink. The goal is to prevent nausea and vomiting during the process of anesthesia and surgery. If the patient is not in a fasting state, the operation will be cancelled or postponed. 
  • It is never a good idea to smoke, but it is especially important not to smoke after midnight prior to having surgery.
  • Makeup should be removed. This enables us to detect any changes in your skin color and your medical condition during anesthesia, surgery and recovery. Women are kindly requested to remove any nail polish on their fingers and toes.
  • A good night’s sleep is advisable the night before surgery. If one has problems falling asleep in the department, it is possible to ask for a sedative or sleeping pill. Please contact the nursing staff.

To assist those in imminent danger and immediate need, we may need to delay or even cancel surgery. In such an event, we will appreciate your understanding.

As the patient’s turn for surgery approaches, the nurse in the ward will inform the patient and family. The patient will be requested to go to the bathroom, if needed. Te patient will be given elastic socks to wear in order to decrease the risk of deep vein thrombosis. All personal items and valuables should be left in the ward such as jewelry, hairpins, contact lenses and dentures. The orderly will transfer the patient to the operating department, that is located on -1 floor, wing A. One family member may accompany the patient to the waiting area until he/she goes into surgery.

In the reception area, the admitting nurse will validate all information, will speak to the patient and make sure all the necessary preparations were made for the surgery and will answer any questions the patient might have. The anesthetist will speak to the patient and explain the type of anesthesia that will be used. The anesthetist, orderly and nurse will accompany the patient to the operating room. 

Operating room: The operating room is a clean environment suitable for surgery. The operating table is situated in the center of the room and above it are the surgery lamps. Surrounding the table is the equipment used in the anesthesia, surgery and monitoring. When the patient is situated on the table, his/her arms will be placed on padded armrests, an intravenous drip will be administered, a blood pressure cuff will be attached to the upper arm, a finger-pulse oximeter for measuring the oxygen-saturation level in the blood will be attached to the patient’s finger and monitoring equipment (sticker-like patches) will be placed on the skin to measure the heart rate. As these preparations are getting underway, the nurse will be preparing the equipment needed for surgery.

Following surgery, the patient will be transferred to the recovery room accompanied by the medical and nursing staff who participated in the operation. In the recovery room, the patient will be handled by the anesthesiology team who will care for pain prevention, treatment of nausea and vomiting, maintaining the patient’s personal safety and providing medical treatment and ongoing care. If needed, the patient is transferred to the Intensive Care Unit, otherwise he/she is accompanied back to the inpatient. 


Post-operative pathway

Over the last years, postoperative care has been standardized through the application of structured multidisciplinary plans, known as postoperative clinical pathways.

Postoperative clinical pathways provide a timeline of the ideal sequence of treatments with a daily schedule outlining the progress of patients without postoperative complications. The pathway organizes and structures care for the benefit of patients and families, and encourages team building while educating and empowering all members of the healthcare delivery system. Additionally, they are excellent educational tools for residents, providing a structured map of postoperative care they can internalize and apply in the future. Standardization of peri-operative management using clinical pathways could also be a means of intra- and inter-institutional quality control of clinical trials.

Postoperative clinical pathways are based on ‘‘enhanced recovery’’ or ‘‘fast-track’’ concepts, which consist in multi-modal strategies that aim to restore the functional capacity of surgical patients to their premorbid state faster and more effectively than the conventional peri-operative approaches. The principal items of postoperative clinical pathways for pancreatic resections are outlined below:

  • Efficient and aggressive pain control in the firs post-operative period
  • Early mobilization (get out of bed, sit in a chair, and begin ambulating from the first postoperative day
  • Structured program of chest physiotherapy
  • Early oral feeding (starting from postoperative day 2)
  • Early device removal (nasogastric tube on day 0-1, urine catheter on day 2, intra-abdominal drains on day 3)
  • Discharge planning

As said, clinical pathways stremline the care of patients with an uneventful post-operative course. Deviations from the pathway are necessary if complications develop. This is the case of nearly half patients. Pancreatic resections are in fact associated with a complication rate as high as 40-50%. For more information on postoperative complications click here. On the contrary, patients who underwent minimally invasive pancreatic surgery may experience a very quick recovery and can be discharged early, within postoperative day 4-5.


Learn more:

Kennedy et al. J Am Coll Surg 2007;204:917-923

Kennedy EP et al. J Gastrointest Surg 2009;13:938-944

Berberat PO et al. J Gastrointest Surg 2007;7:880-887

Balzano G et al. Br J Surg 2008;11:1387-1393

Salvia R, et al. J Surg Oncol 2013;107:51-57