View source for Surgery

{{short description|Medical procedures that involve incisive or invasive instruments into body cavities}}
{{About|the medical specialty}}
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'''Surgery'''{{efn|From the {{langx|el|χειρουργική}} ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via {{langx|la|chirurgiae}}, meaning "hand work"}} is a [[medical specialty]] that uses manual and instrumental techniques to diagnose or treat [[pathological]] conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by [[bariatric surgery]] such as [[gastric bypass]]), to reconstruct or improve aesthetics and appearance ([[cosmetic surgery]]), or to remove unwanted [[tissue (biology)|tissue]]s ([[body fat]], [[gland]]s, [[scar]]s or [[skin tag]]s) or [[foreign bodies]].
The act of performing surgery may be called a '''surgical procedure''' or '''surgical operation''', or simply "surgery" or "operation". In this context, the verb "operate" means to perform surgery. The adjective '''surgical''' means pertaining to surgery; e.g. [[surgical instrument]]s, [[operating theater|surgical facility]] or [[surgical nurse]]. Most surgical procedures are performed by a pair of operators: a [[surgeon]] who is the main operator performing the surgery, and a [[surgical assistant]] who provides in-procedure manual assistance during surgery. Modern surgical operations typically require a '''surgical team''' that typically consists of the surgeon, the surgical assistant, an [[anaesthetist]] (often also complemented by an [[anaesthetic nurse]]), a [[scrub nurse]] (who handles [[asepsis|sterile]] equipment), a [[circulating nurse]] and a [[surgical technologist]], while procedures that mandate [[cardiopulmonary bypass]] will also have a [[perfusionist]]. All surgical procedures are considered ''invasive'' and often require a period of ''postoperative'' care (sometimes [[intensive care]]) for the patient to recover from the [[iatrogenic]] trauma inflicted by the procedure. The duration of surgery can span from several minutes to tens of hours depending on the [[specialty (medicine)|specialty]], the nature of the condition, the target [[wikt:body part|body part]]s involved and the circumstance of each procedure, but most surgeries are designed to be one-off interventions that are typically not intended as an ongoing or repeated type of treatment.
In British colloquialism, the term "surgery" can also refer to the facility where surgery is performed, or simply the [[doctor's office|office]]/[[clinic]] of a [[physician]],<ref>{{cite encyclopedia|url=https://www.collinsdictionary.com/dictionary/english/doctors-surgery|title=Doctor's surgery|dictionary=Collins English Dictionary|access-date=10 February 2018|url-status=live|archive-url=https://web.archive.org/web/20180210062151/https://www.collinsdictionary.com/dictionary/english/doctors-surgery|archive-date=10 February 2018|df=dmy-all}}</ref> [[dentist]] or [[veterinarian]].<ref>{{Cite book |url=https://books.google.com/books?id=UTJbAAAAcAAJ |title=The Medical times: a journal of medical science, literature, criticism, and news. 1845/46, Sept. - Apr. |date=1846 |language=en}}</ref>
== Definitions ==
[[File:Leikkaus Punaisen ristin sairaalassa Tampereella (26875894332).jpg|thumb|Surgery underway at the [[Red Cross]] Hospital in [[Tampere]], [[Finland]] during the 1918 [[Finnish Civil War]].]]
As a general rule, a procedure is considered surgical when it involves cutting of a person's tissues or closure of a previously sustained wound. Other procedures that do not necessarily fall under this rubric, such as [[angioplasty]] or [[endoscopy]], may be considered surgery if they involve "common" surgical procedure or settings, such as use of [[antiseptic]] measures and sterile fields, [[sedation]]/[[anesthesia]], proactive [[hemostasis]], typical [[surgical instrument]]s, [[suturing]] or [[surgical staple|stapling]].  All forms of surgery are considered invasive procedures; the so-called "noninvasive surgery" ought to be more appropriately called [[minimally invasive procedure]]s, which usually refers to a procedure that utilizes natural orifices (e.g. most [[urological]] procedures) or does not penetrate the structure being excised (e.g. endoscopic [[polypectomy|polyp excision]], [[rubber band ligation]], [[LASIK|laser eye surgery]]), are [[percutaneous]] (e.g. [[arthroscopy]], [[catheter ablation]], [[angioplasty]] and [[valvuloplasty]]), or to a [[radiotherapy|radiosurgical]] procedure (e.g. irradiation of a tumor).{{citation needed|date=May 2023}}
===Types of surgery===
Surgical procedures are commonly categorized by urgency, type of procedure, body system involved, the degree of invasiveness, and special instrumentation.
* Based on timing:{{citation needed|date=May 2023}}
** [[Elective surgery]] is done to correct a non-life-threatening condition, and is carried out at the person's convenience, or to the surgeon's and the surgical facility's availability.
** [[Semi-elective surgery]] is one that is better done early to avoid complications or potential deterioration of the patient's condition, but such risk are sufficiently low that the procedure can be postponed for a short period time.
** [[Emergency surgery]] is surgery which must be done without any delay to prevent death or serious disabilities and/or loss of limbs and functions.
* Based on purpose:{{citation needed|date=May 2023}}
** [[Exploratory surgery]] is performed to establish or aid a [[diagnosis]].
** Therapeutic surgery is performed to treat a previously diagnosed condition.
*** Curative surgery is a therapeutic procedure done to permanently remove a pathology.
** [[Plastic surgery]] is done to improve a body part's function and/or appearance.
*** [[Reconstructive plastic surgery]] is done to improve the function and/or subjective appearance of a damaged or malformed body part.<ref>{{Cite web |title=Reconstructive Procedures |url=https://www.plasticsurgery.org/reconstructive-procedures |access-date=2024-05-24 |website=American Society of Plastic Surgeons |language=en}}</ref>
*** [[Cosmetic surgery]] is done to subjectively improve the appearance of an otherwise normal body part.<ref>{{Cite web |title=Cosmetic Procedures |url=https://www.plasticsurgery.org/cosmetic-procedures |access-date=2024-05-24 |website=American Society of Plastic Surgeons |language=en}}</ref>
** [[Bariatric surgery]] is done to assist [[weight loss]] when dietary and pharmaceutical methods alone have failed.
{{anchor|Resection}}
* By type of procedure:
** '''[[Amputation]]''' involves removing an entire [[wikt:body part|body part]], usually a [[limb (anatomy)|limb]] or [[digit (anatomy)|digit]]; [[castration]] is the amputation of [[testes]]; [[circumcision]] is the removal of [[Foreskin|prepuce]] from the [[Human penis|penis]] or [[clitoral hood]] from the [[clitoris]] (see [[female circumcision]]). '''[[Replantation]]''' involves reattaching a severed body part.
** '''Resection''' is the removal of all or part of an [[internal organ]] and/or [[connective tissue]]. A [[segmental resection]] specifically removes an independent vascular region of an organ such as a [[lobes of liver|hepatic segment]], a [[bronchopulmonary segment]] or a [[renal lobe]].<ref name="NCI">{{cite web |title=segmental resection |url=https://www.cancer.gov/publications/dictionaries/cancer-terms/def/segmental-resection |website=National Cancer Institute Dictionary of Cancer Terms |access-date=31 July 2020 |language=en }}</ref> '''Excision''' is the resection of only part of an organ, tissue or other body part (e.g. [[skin]]) without discriminating specific vascular territories. '''Exenteration''' is the complete removal of all organs and [[soft tissue]] content (especially [[lymphoid tissue]]s) within a [[body cavity]].
** '''[[Surgical extirpation|Extirpation]]''' is the complete excision or surgical destruction of a body part.<ref>{{cite web|url=https://www.merriam-webster.com/medical/extirpation|title=extirpation|website=[[Merriam-Webster]] dictionary|access-date=2020-02-20}}</ref>
** '''[[Ablation]]''' is destruction of tissue through the use of energy-transmitting devices such as [[electrocautery]]/[[fulguration]], [[laser ablation|laser]], [[focused ultrasound]] or [[cryoablation|freezing]].
** '''Repair''' involves the direct closure or restoration of an injured, mutilated or deformed organ or body part, usually by [[suturing]] or [[internal fixation]]. '''[[Reconstructive surgery|Reconstruction]]''' is an extensive repair of a complex body part (such as [[joint]]s), often with some degrees of structural/functional replacement and commonly involves grafting and/or use of implants.
** '''[[Graft (surgery)|Grafting]]''' is the relocation and establishment of a tissue from one part of the body to another. A [[flap (surgery)|flap]] is the relocation of a tissue without complete separation of its original attachment, and a [[free flap]] is a completely detached flap that carries an intact neurovascular structure ready for grafting onto a new location.
** '''[[Bypass surgery|Bypass]]''' involves the relocation/grafting of a tubular structure onto another in order to reroute the content flow of that target structure from a specific segment directly to a more distal ("downstream") segment.
** '''[[Implant (medicine)|Implant]]ation''' is insertion of artificial [[medical device]]s to replace or augment existing tissue.
** '''[[Organ transplantation|Transplant]]ation''' is the replacement of an organ or body part by insertion of another from a different human (or animal) into the person undergoing surgery. '''[[Organ procurement|Harvesting]]''' is the resection of an organ or body part from a live human or animal (known as the ''[[organ donation|donor]]'') for transplantation into another patient (known as the ''recipient'').
* By [[organ system]]: Surgical specialties are traditionally and academically categorized by the organ, organ system or body region involved. Examples include:
** [[Cardiac surgery]] — the [[heart]] and [[mediastinal]] [[great vessels]];
** [[Thoracic surgery]] — the [[thoracic cavity]] including the [[lung]]s;
** [[Gastrointestinal surgery]] — the [[digestive tract]] and its accessory organs;
** [[Vascular surgery]] — the extra-mediastinal great vessels and peripheral [[circulatory system]];
** [[Urological surgery]] — the [[genitourinary system]];
** [[ENT surgery]] — [[ear]], [[nose]] and [[throat]], also known as [[head and neck surgery]] when including the [[neck]] region;
** [[Oral and maxillofacial surgery]] — the [[oral cavity]], jaws, and face;
** [[Neurosurgery]] — the [[central nervous system]], and;
** [[Orthopedic surgery]] — the [[musculoskeletal system]].
* By degree of invasiveness of surgical procedures:
** Conventional [[open surgery]] (such as a [[laparotomy]]) requires a large incision to access the area of interest, and directly exposes the internal body cavity to the outside.
** [[Minimally-invasive procedures|Minimally-invasive surgery]] involves much smaller surface incisions or even natural orifices ([[nostril]], [[mouth]], [[anus]] or [[urethra]]) to insert miniaturized instruments within a body cavity or structure, as in [[laparoscopic surgery]] or [[angioplasty]].
** Hybrid surgery uses a combination of open and minimally-invasive techniques, and may include hand ports or larger incisions to assist with performance of elements of the procedure.
* By equipment used:
** [[Laser surgery]] involves use of [[laser ablation]] to divide tissue instead of a [[scalpel]], [[scissors]] or similar sharp-edged instruments.
** [[Cryosurgery]] uses low-temperature [[cryoablation]] to freeze and destroy a target tissue.
** [[Electrosurgery]] involves use of [[electrocautery]] to cut and coagulate tissue.
** [[Microsurgery]] involves the use of an operating [[microscope]] for the surgeon to see and manipulate small structures.
** [[Endoscopic surgery]] uses [[optical instrument]]s to relay the image from inside an enclosed body cavity to the outside, and the surgeon performs the procedure using specialized handheld instruments inserted through [[trocar]]s placed through the body wall. Most modern endoscopic procedures are ''video-assisted'', meaning the images are viewed on a [[electronic visual display|display screen]] rather than through the [[eyepiece]] on the endoscope.
** [[Robotic surgery]] makes use of [[robotics]] such as the [[Da Vinci Surgical System|Da Vinci]] or the [[ZEUS robotic surgical system]]s, to [[remote control|remotely control]] endoscopic or minimally-invasive instruments.
===Terminology===
{{main|List of surgical procedures}}
* Resection and excisional procedures start with a [[prefix]] for the target organ to be excised (cut out) and end in the [[suffix]] '''-ectomy'''.  For example, removal of part of the stomach would be called a subtotal gastrectomy.
* Procedures involving cutting into an organ or tissue end in '''-otomy'''.  A surgical procedure cutting through the [[abdominal]] wall to gain access to the [[abdominal cavity]] is a [[laparotomy]].
* [[Minimally invasive surgery#Minimally invasive procedure|Minimally invasive procedures]], involving small incisions through which an endoscope is inserted, end in -'''oscopy'''. For example, such surgery in the abdominal cavity is called [[laparoscopy]].
* Procedures for formation of a permanent or semi-permanent opening called a [[Stoma (medicine)|stoma]] in the body end in '''-ostomy''', such as creation of a colostomy, a connection of colon and the abdominal wall.  This prefix is also used for connection between two viscera, such as how an esophagojejunostomy refers to a connection created between the esophagus and the jejunum.
* Plastic and reconstruction procedures start with the name for the body part to be reconstructed and end in '''-plasty'''.  For example, ''rhino-'' is a prefix meaning "nose", therefore a ''[[rhinoplasty]]'' is a reconstructive or cosmetic surgery for the nose. A pyloroplasty refers to a type of reconstruction of the gastric pylorus.
* Procedures that involve cutting the muscular layers of an organ end in '''-myotomy'''.  A pyloromyotomy refers to cutting the muscular layers of the gastric pylorus.
* Repair of a damaged or abnormal structure ends in '''-orraphy'''.  This includes herniorrhaphy, another name for a hernia repair.
* Reoperation, revision, or "redo" procedures refer to a planned or unplanned return to the operating theater after a surgery is performed to re-address an aspect of patient care. Unplanned reasons for reoperation include postoperative [[complication (medicine)|complication]]s such as [[bleeding]] or hematoma formation, development of a [[seroma]] or [[abscess]], anastomotic leak, tissue [[necrosis]] requiring [[debridement]] or excision, or in the case of malignancy, close or involved [[resection margin]]s that may require re-excision to avoid local recurrence. Reoperation can be performed in the acute phase, or it can be also performed months to years later if the surgery failed to solve the indicated problem.  Reoperation can also be planned as a staged operation where components of the procedure are performed and/or reversed under separate anesthesia.
== 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 }}</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 }}</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 |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> Moreover, it has been identified that patients who have undergone surgery are often not fully recovered on discharge.{{citation needed|date=May 2023}}
==Epidemiology==
===United States===
In 2011, of the 38.6&nbsp;million hospital stays in U.S. hospitals, 29% included at least one operating room procedure. These stays accounted for 48% of the total $387&nbsp;billion in hospital costs.<ref>{{cite journal | title = Characteristics of Operating Room Procedures in U.S. Hospitals, 2011. | journal = HCUP Statistical Brief No. 170 | date = February 2014 | pmid = 24716251 | url = http://hcup-us.ahrq.gov/reports/statbriefs/sb170-Operating-Room-Procedures-United-States-2011.jsp | url-status = live | publisher = Agency for Healthcare Research and Quality | df = dmy-all | archive-url = https://web.archive.org/web/20140328234122/http://hcup-us.ahrq.gov/reports/statbriefs/sb170-Operating-Room-Procedures-United-States-2011.jsp | archive-date = 28 March 2014 | last1 = Weiss | first1 = A. J. | last2 = Elixhauser | first2 = A. | last3 = Andrews | first3 = R. M. }}</ref>
The overall number of procedures remained stable from 2001 to 2011. In 2011, over 15 million operating room procedures were performed in U.S. hospitals.<ref>{{cite journal | title = Trends in Operating Room Procedures in U.S. Hospitals, 2001–2011 | journal = HCUP Statistical Brief No. 171 | date = March 2014 | pmid = 24851286 | url = http://hcup-us.ahrq.gov/reports/statbriefs/sb171-Operating-Room-Procedure-Trends.jsp | url-status = live | publisher = Agency for Healthcare Research and Quality | df = dmy-all | archive-url = https://web.archive.org/web/20140328235555/http://hcup-us.ahrq.gov/reports/statbriefs/sb171-Operating-Room-Procedure-Trends.jsp | archive-date = 28 March 2014 | last1 = Weiss | first1 = A. J. | last2 = Elixhauser | first2 = A. }}</ref>
Data from 2003 to 2011 showed that U.S. hospital costs were highest for the surgical service line; the surgical service line costs were $17,600 in 2003 and projected to be $22,500 in 2013.<ref>{{cite journal | title = Trends and Projections in Inpatient Hospital Costs and Utilization, 2003–2013 | journal = HCUP Statistical Brief No. 175 | date = July 2014 | pmid = 25165806 | url = https://www.hcup-us.ahrq.gov/reports/statbriefs/sb175-Hospital-Cost-Utilization-Projections-2013.jsp | url-status = live | publisher = Agency for Healthcare Research and Quality | df = dmy-all | archive-url = https://web.archive.org/web/20140803212302/http://www.hcup-us.ahrq.gov/reports/statbriefs/sb175-Hospital-Cost-Utilization-Projections-2013.jsp | archive-date = 3 August 2014 | last1 = Weiss | first1 = A. J. | last2 = Barrett | first2 = M. L. | last3 = Steiner | first3 = C. A. }}</ref> For hospital stays in 2012 in the United States, private insurance had the highest percentage of surgical expenditure.<ref name="Moore B, Levit K and Elixhauser A">{{cite journal | title = Costs for Hospital Stays in the United States, 2012 | journal = HCUP Statistical Brief No. 181 | date = October 2014 | pmid = 25521003 | url = https://www.hcup-us.ahrq.gov/reports/statbriefs/sb181-Hospital-Costs-United-States-2012.jsp | url-status = live | publisher = Agency for Healthcare Research and Quality | df = dmy-all | archive-url = https://web.archive.org/web/20141129104404/https://www.hcup-us.ahrq.gov/reports/statbriefs/sb181-Hospital-Costs-United-States-2012.jsp | archive-date = 29 November 2014 | last1 = Moore | first1 = B. | last2 = Levit | first2 = K. | last3 = Elixhauser | first3 = A. }}</ref> in 2012, mean hospital costs in the United States were highest for surgical stays.<ref name="Moore B, Levit K and Elixhauser A"/>
==Special populations==
===Elderly people===
Older adults have widely varying physical health.  [[Frailty syndrome|Frail elderly]] people are at significant risk of post-surgical complications and the need for extended care.  Assessment of older people before elective surgery can accurately predict the person's recovery trajectories.<ref name=Frailty>{{cite journal | vauthors = Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, Takenaga R, Devgan L, Holzmueller CG, Tian J, Fried LP | title = Frailty as a predictor of surgical outcomes in older patients | journal = Journal of the American College of Surgeons | volume = 210 | issue = 6 | pages = 901–908 | date = June 2010 | pmid = 20510798 | doi = 10.1016/j.jamcollsurg.2010.01.028 }}</ref> One frailty scale uses five items:  unintentional weight loss, [[muscle weakness]], exhaustion, low physical activity, and slowed walking speed.  A healthy person scores 0; a very frail person scores 5.  Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in the hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes.<ref name=Frailty /> People who are frail and elderly (score of 4 or 5) have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people.{{citation needed|date=May 2023}}
===Children===
Surgery on children requires considerations that are not common in adult surgery. Children and adolescents are still developing physically and mentally making it difficult for them to make informed decisions and give consent for surgical treatments. [[Bariatric Surgery#Youth|Bariatric surgery in youth]] is among the controversial topics related to surgery in children.{{citation needed|date=May 2023}}
{{See also|Pediatric surgery|Pediatric plastic surgery}}
===Vulnerable populations===
Doctors perform surgery with the consent of the person undergoing surgery. Some people are able to give better [[informed consent]] than others. Populations such as [[Incarceration|incarcerated persons]], [[dementia|people living with dementia]], the mentally incompetent, persons subject to coercion, and other people who are not able to make decisions with the same authority as others, have special needs when making decisions about their personal healthcare, including surgery.
==Global surgery==
Global surgery has been defined as 'the [[multidisciplinary]] enterprise of providing improved and equitable surgical care to the world's population, with its core belief as the issues of need, access and quality".<ref>{{cite journal | vauthors = Bath M, Bashford T, Fitzgerald JE | title = What is 'global surgery'? Defining the multidisciplinary interface between surgery, anaesthesia and public health | journal = BMJ Global Health | volume = 4 | issue = 5 | pages = e001808 | year = 2019 | pmid = 31749997 | pmc = 6830053 | doi = 10.1136/bmjgh-2019-001808 }}</ref> [[Halfdan T. Mahler]], the 3rd Director-General of [[World Health Organization|the World Health Organization (WHO)]], first brought attention to the disparities in surgery and surgical care in 1980 when he stated in his address to the World Congress of the International College of Surgeons, "'the vast majority of the world's population has no access whatsoever to skilled surgical care and little is being done to find a solution.As such, surgical care globally has been described as the 'neglected stepchild of global health,' a term coined by [[Paul Farmer]] to highlight the urgent need for further work in this area.<ref>{{cite journal | vauthors = Farmer PE, Kim JY | title = Surgery and global health: a view from beyond the OR | journal = World Journal of Surgery | volume = 32 | issue = 4 | pages = 533–536 | date = April 2008 | pmid = 18311574 | pmc = 2267857 | doi = 10.1007/s00268-008-9525-9 }}</ref> Furthermore, [[Jim Yong Kim|Jim Young Kim]], the former President of the [[World Bank]], proclaimed in 2014 that "surgery is an indivisible, indispensable part of health care and of progress towards universal health coverage."<ref>{{cite journal | vauthors = Dare AJ, Grimes CE, Gillies R, Greenberg SL, Hagander L, Meara JG, Leather AJ | title = Global surgery: defining an emerging global health field | journal = Lancet | volume = 384 | issue = 9961 | pages = 2245–2247 | date = December 2014 | pmid = 24853601 | doi = 10.1016/S0140-6736(14)60237-3 | s2cid = 37349469 }}</ref>
In 2015, the Lancet Commission on Global Surgery (LCoGS) published the landmark report titled "Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development", describing the large, pre-existing burden of surgical diseases in low- and middle-income countries (LMICs) and future directions for increasing universal access to safe surgery by the year 2030.<ref name=":2">{{cite journal | vauthors = Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA, Bickler SW, Conteh L, Dare AJ, Davies J, Mérisier ED, El-Halabi S, Farmer PE, Gawande A, Gillies R, Greenberg SL, Grimes CE, Gruen RL, Ismail EA, Kamara TB, Lavy C, Lundeg G, Mkandawire NC, Raykar NP, Riesel JN, Rodas E, Rose J, Roy N, Shrime MG, Sullivan R, Verguet S, Watters D, Weiser TG, Wilson IH, Yamey G, Yip W | title = Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development | journal = Lancet | volume = 386 | issue = 9993 | pages = 569–624 | date = August 2015 | pmid = 25924834 | doi = 10.1016/S0140-6736(15)60160-X | s2cid = 2048403 | doi-access = free }}</ref> The Commission highlighted that about 5 billion people lack access to safe and affordable surgical and anesthesia care and 143 million additional procedures were needed every year to prevent further [[morbidity]] and [[Mortality rate|mortality]] from treatable surgical conditions as well as a $12.3 trillion loss in economic productivity by the year 2030.<ref name=":2" /> This was especially true in the poorest countries, which account for over one-third of the population but only 3.5% of all surgeries that occur worldwide.<ref>{{cite journal | vauthors = Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, Gawande AA | title = An estimation of the global volume of surgery: a modelling strategy based on available data | language = English | journal = Lancet | volume = 372 | issue = 9633 | pages = 139–144 | date = July 2008 | pmid = 18582931 | doi = 10.1016/S0140-6736(08)60878-8 | s2cid = 17918156 }}</ref> It emphasized the need to significantly improve the capacity for Bellwether procedures – [[laparotomy]], [[caesarean section]], [[Open fracture|open fracture care]] – which are considered a minimum level of care that first-level hospitals should be able to provide in order to capture the most basic emergency surgical care.<ref name=":2" /><ref>{{cite journal | vauthors = O'Neill KM, Greenberg SL, Cherian M, Gillies RD, Daniels KM, Roy N, Raykar NP, Riesel JN, Spiegel D, Watters DA, Gruen RL | title = Bellwether Procedures for Monitoring and Planning Essential Surgical Care in Low- and Middle-Income Countries: Caesarean Delivery, Laparotomy, and Treatment of Open Fractures | journal = World Journal of Surgery | volume = 40 | issue = 11 | pages = 2611–2619 | date = November 2016 | pmid = 27351714 | doi = 10.1007/s00268-016-3614-y | publisher = Springer Science and Business Media LLC | s2cid = 12830913 }}</ref> In terms of the financial impact on the patients, the lack of adequate surgical and anesthesia care has resulted in 33 million individuals every year facing catastrophic health expenditure – the out-of-pocket healthcare cost exceeding 40% of a given household's income.<ref name=":2" /><ref>{{cite journal | vauthors = Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ | title = Household catastrophic health expenditure: a multicountry analysis | journal = Lancet | volume = 362 | issue = 9378 | pages = 111–117 | date = July 2003 | pmid = 12867110 | doi = 10.1016/S0140-6736(03)13861-5 | s2cid = 2052830 }}</ref>
In alignment with the LCoGS call for action, the [[World Health Assembly]] adopted the resolution WHA68.15 in 2015 that stated, "Strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage."<ref name="World Health Assembly Resolution WH">{{cite journal | vauthors = Price R, Makasa E, Hollands M | title = World Health Assembly Resolution WHA68.15: "Strengthening Emergency and Essential Surgical Care and Anesthesia as a Component of Universal Health Coverage"—Addressing the Public Health Gaps Arising from Lack of Safe, Affordable and Accessible Surgical and Anesthetic Services | journal = World Journal of Surgery | volume = 39 | issue = 9 | pages = 2115–2125 | date = September 2015 | pmid = 26239773 | doi = 10.1007/s00268-015-3153-y | s2cid = 13027859 }}</ref> This not only mandated the [[World Health Organization|WHO]] to prioritize strengthening the surgical and anesthesia care globally, but also led to governments of the member states recognizing the urgent need for increasing capacity in surgery and anesthesia. Additionally, the third edition of [[Disease Control Priorities Project|Disease Control Priorities]] (DCP3), published in 2015 by the [[World Bank]], declared surgery as essential and featured an entire volume dedicated to building surgical capacity.<ref>{{Cite book | vauthors = Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN |editor-first1=Haile T. |editor-first2=Peter |editor-first3=Atul |editor-first4=Dean T. |editor-first5=Margaret E. |editor-first6=Charles N. |editor-last1=Debas |editor-last2=Donkor |editor-last3=Gawande |editor-last4=Jamison |editor-last5=Kruk |editor-last6=Mock |date=2015-03-24 |title=Disease Control Priorities | edition = Third | volume = 1 Essential Surgery |doi=10.1596/978-1-4648-0346-8 |pmid=26740991 |hdl=10986/21568 |isbn=978-1-4648-0346-8 |url=https://openknowledge.worldbank.org/handle/10986/21568 |language=en-US}}</ref>
Data from WHO and the World Bank indicate that scaling up infrastructure to enable access to surgical care in regions where it is currently limited or is non-existent is a low-cost measure relative to the significant morbidity and mortality caused by lack of surgical treatment.<ref name=":3">{{cite journal | vauthors = McQueen KA, Ozgediz D, Riviello R, Hsia RY, Jayaraman S, Sullivan SR, Meara JG | title = Essential surgery: Integral to the right to health | journal = Health and Human Rights | volume = 12 | issue = 1 | pages = 137–152 | date = June 2010 | pmid = 20930260 | url = https://www.hhrjournal.org/2013/08/essential-surgery-integral-to-the-right-to-health/ }}</ref> In fact, a systematic review found that the [[Cost-effectiveness|cost-effectiveness ratio]] – dollars spent per DALYs averted – for surgical interventions is on par or exceeds those of major public health interventions such as [[oral rehydration therapy]], [[breastfeeding promotion]], and even [[Management of HIV/AIDS|HIV/AIDS antiretroviral therapy]].<ref>{{cite journal | vauthors = Chao TE, Sharma K, Mandigo M, Hagander L, Resch SC, Weiser TG, Meara JG | title = Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis | language = English | journal = The Lancet. Global Health | volume = 2 | issue = 6 | pages = e334–e345 | date = June 2014 | pmid = 25103302 | doi = 10.1016/S2214-109X(14)70213-X | doi-access = free }}</ref> This finding challenged the common misconception that surgical care is financially prohibitive endeavor not worth pursuing in LMICs.
A key policy framework that arose from this renewed global commitment towards surgical care worldwide is the National Surgical Obstetric and Anesthesia Plan (NSOAP).<ref name=":4">{{cite journal | vauthors = Truché P, Shoman H, Reddy CL, Jumbam DT, Ashby J, Mazhiqi A, Wurdeman T, Ameh EA, Smith M, Lugazia E, Makasa E, Park KB, Meara JG | title = Globalization of national surgical, obstetric and anesthesia plans: the critical link between health policy and action in global surgery | journal = Globalization and Health | volume = 16 | issue = 1 | pages = 1 | date = January 2020 | pmid = 31898532 | pmc = 6941290 | doi = 10.1186/s12992-019-0531-5 | doi-access = free }}</ref> NSOAP focuses on policy-to-action capacity building for surgical care with tangible steps as follows: (1) analysis of baseline indicators, (2) partnership with local champions, (3) broad stakeholder engagement, (4) consensus building and synthesis of ideas, (5) language refinement, (6) costing, (7) dissemination, and (8) implementation. This approach has been widely adopted and has served as guiding principles between international collaborators and local institutions and governments. Successful implementations have allowed for sustainability in terms of longterm monitoring, quality improvement, and continued political and financial support.<ref name=":4" />
==Human rights==
Access to surgical care is increasingly recognized as an integral aspect of healthcare and therefore is evolving into a normative derivation of human [[right to health]].<ref>{{cite journal |last1=Marks |first1=S |title=Normative Expansion of the Right to Health and the Proliferation of Human Rights |journal=George Washington International Law Review |date=2016 |pages=101–44}}</ref> The [[ICESCR]] Article 12.1 and 12.2 define the human [[right to health]] as "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health"<ref>UN General Assembly. International Covenant on Economic, Social and Cultural Rights – United Nations Treaty Series. In: Nations U, editor. 1966</ref> In the August 2000, the UN [[Committee on Economic, Social and Cultural Rights]] (CESCR) interpreted this to mean "right to the enjoyment of a variety of facilities, goods, services, and conditions necessary for the realization of the highest attainable health".<ref name="Comment No. 14">UN Committee on Economic Social and Cultural Rights. CESCR General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12) 2000</ref> Surgical care can be thereby viewed as a positive right – an entitlement to protective healthcare.<ref name="Comment No. 14"/>
Woven through the International Human and Health Rights literature is the right to be free from surgical disease. The 1966 ICESCR Article 12.2a described the need for "provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child"<ref>UN General Assembly. International Covenant on Economic, Social and Cultural Rights – United Nations Treaty Series. In: Nations U, editor. 1966.</ref> which was subsequently interpreted to mean "requiring measures to improve… emergency obstetric services".<ref name="Comment No. 14"/> Article 12.2d of the ICESCR stipulates the need for "the creation of conditions which would assure to all medical service and medical attention in the event of sickness",<ref>2. UN General Assembly. International Covenant on Economic, Social and Cultural Rights – United Nations Treaty Series. In: Nations U, editor. 1966.</ref> and is interpreted in the 2000 comment to include timely access to "basic preventative, curative services… for appropriate treatment of [[injury]] and [[disability]].".<ref name="Cultural Rights 2000">UN Committee on Economic Social and Cultural Rights. CESCR General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12) 2000.</ref> Obstetric care shares close ties with [[reproductive rights]], which includes access to reproductive health.<ref name="Cultural Rights 2000"/>
Surgeons and [[public health]] advocates, such as [[Kelly McQueen]], have described surgery as "Integral to the [[right to health]]".<ref>{{cite journal | vauthors = McQueen KA, Ozgediz D, Riviello R, Hsia RY, Jayaraman S, Sullivan SR, Meara JG | title = Essential surgery: Integral to the right to health | journal = Health and Human Rights | volume = 12 | issue = 1 | pages = 137–152 | date = June 2010 | pmid = 20930260 }}</ref> This is reflected in the establishment of the WHO [[Global Initiative for Emergency and Essential Surgical Care]] in 2005,<ref>World Health Organization. Global Initiative for Emergency and Essential Surgical Care 2017 [cited 2017 October 23rd]. Available from: {{cite web |url=https://www.who.int/surgery/globalinitiative/en/ |title=WHO Global Initiative for Emergency and Essential Surgical Care |access-date=9 February 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120325203523/http://www.who.int/surgery/globalinitiative/en/ |archive-date=25 March 2012 |df=dmy-all }}</ref> the 2013 formation of the Lancet Commission for Global Surgery,<ref name="auto">{{cite journal | vauthors = Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA, Bickler SW, Conteh L, Dare AJ, Davies J, Mérisier ED, El-Halabi S, Farmer PE, Gawande A, Gillies R, Greenberg SL, Grimes CE, Gruen RL, Ismail EA, Kamara TB, Lavy C, Lundeg G, Mkandawire NC, Raykar NP, Riesel JN, Rodas E, Rose J, Roy N, Shrime MG, Sullivan R, Verguet S, Watters D, Weiser TG, Wilson IH, Yamey G, Yip W | title = Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development | journal = International Journal of Obstetric Anesthesia | volume = 25 | pages = 75–78 | date = February 2016 | pmid = 26597405 | doi = 10.1016/j.ijoa.2015.09.006 }}</ref> the 2015 [[World Bank]] Publication of Volume 1 of its [[Disease Control Priorities Project]] "Essential Surgery",<ref name=":1">Debas HT, Donker P, Gawande A, Jamison DT, Kruk ME, Mock CN, editors. Essential Surgery. Disease Control Priorities. 3rd ed. Washington, DC: International Bank for Reconstruction and Development / World Bank Group; 2015</ref> and the 2015 [[World Health Assembly]] 68.15 passing of the Resolution for Strengthening Emergency and Essential Surgical Care and [[Anesthesia]] as a Component of [[Universal Health Coverage]].<ref name="World Health Assembly Resolution WH"/> The Lancet Commission for Global Surgery outlined the need for access to "available, affordable, timely and safe" surgical and anesthesia care;<ref name="auto"/> dimensions paralleled in [[ICESCR]] General Comment No. 14, which similarly outlines need for available, accessible, affordable and timely healthcare.<ref name="Comment No. 14"/>
==History==
{{Main|History of surgery|Prehistoric medicine|History of general anesthesia}}
[[Image:Edwin Smith Papyrus v2.jpg|thumb|Plates VI and VII of the [[Edwin Smith Papyrus]], an Egyptian surgical treatise]]
===Trepanation===
Surgical treatments date back to the prehistoric era. The oldest for which there is evidence is [[trepanation]],<ref>{{Cite book |author=Capasso, Luigi |year=2002 |title=Principi di storia della patologia umana: corso di storia della medicina per gli studenti della Facoltà di medicina e chirurgia e della Facoltà di scienze infermieristiche |location=Rome |publisher=SEU |isbn=978-88-87753-65-3 |oclc=50485765 |language=it}}</ref> in which a hole is [[drill]]ed or scraped into the [[Human skull|skull]], thus exposing the [[dura mater]] in order to treat health problems related to intracranial pressure.
===Ancient Egypt===
Prehistoric surgical techniques are seen in [[Ancient Egypt]], where a [[Human mandible|mandible]] dated to approximately 2650 BC shows two perforations just below the root of the first [[molar (tooth)|molar]], indicating the draining of an [[Tooth abscess|abscessed tooth]]. Surgical texts from ancient Egypt date back about 3500 years ago. Surgical operations were performed by priests, specialized in medical treatments similar to today,<ref name=cossurg>{{cite book| vauthors = Shiffman M |title=Cosmetic Surgery: Art and Techniques|publisher=Springer|isbn=978-3-642-21837-8|page=20|year=2012}}</ref> and used sutures to close wounds.<ref>{{cite journal | vauthors = Sullivan R | title = The identity and work of the ancient Egyptian surgeon | journal = Journal of the Royal Society of Medicine | volume = 89 | issue = 8 | pages = 467–473 | date = August 1996 | pmid = 8795503 | pmc = 1295891 | doi = 10.1177/014107689608900813 }}</ref> Infections were treated with honey.<ref>James P. Allen, ''The Art of Medicine in Ancient Egypt''. (New York: The Metropolitan Museum of Art, 2005) 72.</ref>
===India===
9,000-year-old skeletal remains of a prehistoric individual from the [[Indus River Valley|Indus River valley]] show evidence of teeth having been drilled.<ref>{{cite news | url=http://news.bbc.co.uk/1/hi/sci/tech/4882968.stm | work=BBC News | title=Stone age man used dentist drill | date=6 April 2006 | access-date=24 May 2010 | url-status=live | archive-url=https://web.archive.org/web/20090422144638/http://news.bbc.co.uk/1/hi/sci/tech/4882968.stm | archive-date=22 April 2009 | df=dmy-all }}</ref> ''[[Sushruta Samhita]]'' is one of the oldest known surgical texts and its period is usually placed in the first millennium BCE.<ref name="singhguide">{{cite book |title=Banaras Region: A Spiritual and Cultural Guide | vauthors = Singh PB, Rana PS |year=2002 |publisher=Indica Books |location=Varanasi |isbn=978-81-86569-24-5 |page=31 }}</ref> It describes in detail the examination, diagnosis, treatment, and prognosis of numerous ailments, as well as procedures for various forms of cosmetic surgery, [[plastic surgery]] and [[rhinoplasty]].<ref>{{Cite journal|url=https://www.jpgmonline.com/article.asp?issn=0022-3859;year=2002;volume=48;issue=1;spage=76;epage=8;aulast=Rana;type=0|archiveurl=https://web.archive.org/web/20090301014540/http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2002;volume=48;issue=1;spage=76;epage=8;aulast=Rana|url-status=dead|title=History of plastic surgery in India.|first1=R. E.|last1=Rana|first2=B. S.|last2=Arora|date=1 January 2002|archivedate=1 March 2009|journal=Journal of Postgraduate Medicine|volume=48|issue=1|pages=76–78|via=www.jpgmonline.com|pmid=12082339}}</ref>
=== Sri Lanka ===
In 1982 archaeologists were able to find significant evidence when the ancient land, called 'Alahana Pirivena' situated in Polonnaruwa, with ruins, was excavated. In that place ruins of an ancient hospital emerged. The hospital building was 147.5 feet in width and 109.2 feet in length. The instruments which were used for complex surgeries were there among the things discovered from the place, including forceps, scissors, probes, lancets, and scalpels. The instruments discovered may be dated to 11th century AD.<ref>Somadewa, Raj; Rev. Deerananda, Hanguranketha; Kannangara, Padmasiri; Senadhiraja, Anusha; Gunawardhana, W. S. Shiromala (2014). ''[http://www.edupub.gov.lk/Administrator/English/10/history%2010%20E/histoy%20G-10%20E.pdf History - Grade 10]'' (PDF). Translated by Bandara, A.B.S. Aloka. Educational Publications Department. [[ISBN (identifier)|ISBN]] [[Special:BookSources/978-955-25-0663-5|<bdi>978-955-25-0663-5</bdi>]].</ref><ref>{{Cite web |title=Surgery in an ancient kingdom |url=https://www.sundaytimes.lk/111030/Plus/plus_01.html |access-date=2023-09-05 |website=www.sundaytimes.lk}}</ref><ref>{{Cite web |last=Aluwihare |first=Arjuna PR |date=3 August 2021 |title=Surgical Instruments at the Alahana Parivena Hospital in Polonnaruwa |url=https://www.clinicsinsurgery.com/open-access/surgical-instruments-at-the-alahana-parivena-hospital-in-polonnaruwa-7783.pdf |url-status=live |archive-url=https://web.archive.org/web/20221004220102/https://www.clinicsinsurgery.com/open-access/surgical-instruments-at-the-alahana-parivena-hospital-in-polonnaruwa-7783.pdf |archive-date=October 4, 2022 |access-date=September 5, 2023 |website=Clinics in Surgery}}</ref><ref>{{Cite web |last=Uragoda |first=C. G. |title=Medicine and Surgery |url=https://dl.nsf.gov.lk/bitstream/handle/1/5517/VIDU%2019_1_9.pdf?sequence=1&isAllowed=y |access-date=5 September 2023 |website=National Science Foundation}}</ref>
===Ancient and Medieval Greece===
[[Image:Hippocrates rubens.jpg|thumb|160px|Bust of [[Hippocrates]], who advocated for surgery to be performed by [[Specialist doctor|specialists]].]]
In [[ancient Greece]], temples dedicated to the healer-god [[Asclepius]], known as ''Asclepieia'' ({{langx|el|Ασκληπιεία}}, sing. ''Asclepieion'' ''Ασκληπιείον''), functioned as centers of medical advice, prognosis, and healing.<ref>Risse, G.B. ''Mending bodies, saving souls: a history of hospitals.'' Oxford University Press, 1990. p. 56 [https://books.google.com/books?id=htLTvdz5HDEC&q=History+of+Hospital%2BAsclepieion&pg=PA56]</ref> In the Asclepieion of [[Epidaurus]], some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place.<ref name=books.google.com /> The Greek [[Galen]] was one of the greatest surgeons of the ancient world and performed many audacious operations&nbsp;– including brain and eye surgery&nbsp;– that were not tried again for almost two millennia. [[Hippocrates]] stated in the [[Hippocratic Oath|oath]] ({{Circa|400 BCE}}) that general physicians must never practice surgery and that surgical procedures are to be conducted by [[Specialist doctor|specialists]]{{citation needed|date=May 2023}}
Researchers from the [[Adelphi University]] discovered in the Paliokastro on [[Thasos]] ten skeletal remains, four women and six men, who were buried between the fourth and seventh centuries A.D. Their bones illuminated their physical activities, traumas, and even a complex form of brain surgery. According to the researchers: "The very serious trauma cases sustained by both males and females had been treated surgically or orthopedically by a very experienced physician/surgeon with great training in trauma care. We believe it to have been a military physician". The researchers were impressed by the complexity of the brain surgical operation.<ref>{{cite web| url = https://www.eurekalert.org/pub_releases/2020-04/au-ard040720.php| title = Adelphi researcher discovers early, complex brain surgery in ancient Greece}}</ref>
In 1991 at the Polystylon fort in Greece, researchers discovered the head of a Byzantine warrior of the 14th century. Analysis of the lower jaw revealed that a surgery has been performed, when the warrior was alive, to the jaw which had been badly fractured and it tied back together until it healed.<ref>{{Cite web|url=https://www.livescience.com/byzantine-warrior-fractured-jaw|title=Byzantine warrior with gold-threaded jaw unearthed in Greece|author1=Laura Geggel|date=29 September 2021|website=livescience.com}}</ref>
===Islamic world===
During the [[Islamic Golden Age]], largely based upon [[Paul of Aegina]]'s ''Pragmateia'', the writings of [[Albucasis]] (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi), an [[Al-Andalus|Andalusian-Arab]] physician and scientist who practiced in the Zahra suburb of [[Córdoba, Spain|Córdoba]], were influential.<ref>{{cite book| vauthors = Zimmerman LM, Veith I |title=Great Ideas in the History of Surgery|url=https://books.google.com/books?id=ABbCI7z4UwMC&pg=PA179|access-date=3 December 2012|year=1993|publisher=Norman Publishing|isbn=978-0-930405-53-3|pages=82–83}}</ref><ref>{{cite book| vauthors = Pormann PE |title=The Oriental Tradition of Paul of Aegina's Pragmateia|url=https://books.google.com/books?id=SszCRRlW5asC|access-date=6 December 2012|year=2004|publisher=Brill|isbn=978-90-04-13757-8|pages=300–04}}</ref> Al-Zahrawi specialized in curing disease by [[cauterization]]. He invented several [[surgical instruments]] for purposes such as inspection of the interior of the [[urethra]] and for removing foreign bodies from the throat, the ear, and other body organs. He was also the first to illustrate the various [[cannulae]] and to treat [[wart]]s with an iron tube and caustic metal{{clarify|date=August 2019}} as a boring instrument. He describes what is thought to be the first attempt at reduction [[mammaplasty]] for the management of [[gynaecomastia]]<ref name=Anzjournal>{{citation| vauthors = Ahmad Z |title=Al-Zahrawi – The Father of Surgery|journal=ANZ Journal of Surgery|year=2007|volume=77|issue=Suppl. 1|doi=10.1111/j.1445-2197.2007.04130_8.x|pages=A83|s2cid=57308997}}</ref> and the first [[mastectomy]] to treat [[breast cancer]].<ref name=aramco0816>{{cite web|url=http://www.islamicity.org/8597/pioneer-muslim-physicians/|title=Pioneer Muslim Physicians|publisher=aramcoworld.com|access-date=20 March 2017|archive-url=https://web.archive.org/web/20170321170835/http://www.islamicity.org/8597/pioneer-muslim-physicians/|archive-date=2017-03-21|url-status=live}}{{better source needed|date=July 2017}}</ref> He is credited with the performance of the first [[thyroidectomy]].<ref>Ignjatovic M: Overview of the history of thyroid surgery. Acta Chir Iugosl 2003; 50: 9–36.</ref> Al-Zahrawi pioneered techniques of [[neurosurgery]] and [[neurological]] diagnosis, treating [[head injuries]], [[skull fractures]], [[spinal injuries]], [[hydrocephalus]], [[subdural effusion]]s and [[headache]]. The first clinical description of an operative procedure for [[hydrocephalus]] was given by Al-Zahrawi, who clearly describes the evacuation of superficial [[intracranial]] fluid in [[hydrocephalic]] children.<ref>{{cite journal | vauthors = Aschoff A, Kremer P, Hashemi B, Kunze S | title = The scientific history of hydrocephalus and its treatment | journal = Neurosurgical Review | volume = 22 | issue = 2–3 | pages = 67–93; discussion 94–95 | date = October 1999 | pmid = 10547004 | doi = 10.1007/s101430050035 | s2cid = 10077885 }}</ref>
===Early modern Europe===
[[File:Augenoperation 1195.jpg|thumb|left|150px|[[Illuminated miniature]] of 12th-century eye surgery in Italy]]
[[File:Ambroise Paré 1573.jpg|thumb|160px|Ambroise Paré (c. 1510–1590), father of modern military surgery.]]
In [[Europe]], the demand grew for surgeons to formally study for many years before practicing; universities such as [[University of Montpellier|Montpellier]], [[University of Padua|Padua]] and [[University of Bologna|Bologna]] were particularly renowned. In the 12th century, [[Rogerius (physician)|Rogerius Salernitanus]] composed his ''Chirurgia'', laying the foundation for modern Western surgical manuals. [[Barber surgeon|Barber-surgeons]] generally had a bad reputation that was not to improve until the development of academic surgery as a specialty of medicine, rather than an accessory field.<ref>{{cite journal | vauthors = Himmelmann L | title = [From barber to surgeon- the process of professionalization] | journal = Svensk Medicinhistorisk Tidskrift | volume = 11 | issue = 1 | pages = 69–87 | year = 2007 | pmid = 18548946 }}</ref> Basic surgical principles for asepsis etc., are known as [[Halsteads principles]].
There were some important advances to the art of surgery during this period. The professor of anatomy at the [[University of Padua]], [[Andreas Vesalius]], was a pivotal figure in the [[Renaissance]] transition from classical medicine and anatomy based on the works of [[Galen]], to an empirical approach of 'hands-on' dissection. In his anatomic treaties ''[[De humani corporis fabrica]]'', he exposed the many anatomical errors in Galen and advocated that all surgeons should train by engaging in practical dissections themselves.{{citation needed|date=May 2023}}
The second figure of importance in this era was [[Ambroise Paré]] (sometimes spelled "Ambrose"<ref>{{cite journal | vauthors = Levine JM | title = Historical notes on pressure ulcers: the cure of Ambrose Paré | journal = Decubitus | volume = 5 | issue = 2 | pages = 23–4, 26 | date = March 1992 | pmid = 1558689 }}</ref>), a French army surgeon from the 1530s until his death in 1590. The practice for cauterizing gunshot wounds on the battlefield had been to use boiling oil; an extremely dangerous and painful procedure. Paré began to employ a less irritating emollient, made of [[egg yolk]], [[rose oil]] and [[turpentine]]. He also described more efficient techniques for the effective [[ligature (medicine)|ligation]] of the [[blood vessel]]s during an [[amputation]].{{citation needed|date=May 2023}}
===Modern surgery===
The discipline of surgery was put on a sound, scientific footing during the [[Age of Enlightenment]] in Europe. An important figure in this regard was the Scottish surgical scientist, [[John Hunter (surgeon)|John Hunter]], generally regarded as the father of modern scientific surgery.<ref>{{cite book|url=https://books.google.com/books?id=BFAsAAAAYAAJ|title=The Knife Man: The Extraordinary Life and Times of John Hunter, Father of Modern Surgery| vauthors = Moore W |year=2005|publisher=Crown Publishing Group|access-date=7 February 2013|isbn=978-0-7679-1652-3}}</ref> He brought an [[empiricism|empirical]] and [[experiment]]al approach to the science and was renowned around Europe for the quality of his research and his written works. Hunter reconstructed surgical knowledge from scratch; refusing to rely on the testimonies of others, he conducted his own surgical experiments to determine the truth of the matter. To aid comparative analysis, he built up a collection of over 13,000 specimens of separate organ systems, from the simplest plants and animals to humans.{{citation needed|date=May 2023}}
He greatly advanced knowledge of [[venereal disease]] and introduced many new techniques of surgery, including new methods for repairing damage to the [[Achilles tendon]] and a more effective method for applying ligature of the [[arteries]] in case of an [[aneurysm]].<ref>{{Cite web|url=http://library.uthscsa.edu/2010/12/john-hunter-%E2%80%9Cthe-father-of-scientific-surgery%E2%80%9D-resources-from-the-collection-of-the-p-i-nixon-library/ |title=John Hunter: "the father of scientific surgery": Resources from the collection of the P.I. Nixon Library |access-date=17 December 2012 |url-status=dead |archive-url=https://web.archive.org/web/20131026210110/http://library.uthscsa.edu/2010/12/john-hunter-%E2%80%9Cthe-father-of-scientific-surgery%E2%80%9D-resources-from-the-collection-of-the-p-i-nixon-library/ |archive-date=26 October 2013 }}</ref> He was also one of the first to understand the importance of [[pathology]], the danger of the spread of [[infection]] and how the problem of [[inflammation]] of the wound, bone [[lesion]]s and even [[tuberculosis]] often undid any benefit that was gained from the intervention. He consequently adopted the position that all surgical procedures should be used only as a last resort.<ref>{{Cite web |url=http://www.healio.com/hematology-oncology/news/print/hematology-oncology/%7BC9A8CA57-FA27-4432-AADF-D8EE0671428F%7D/John-Hunter-Founder-of-Scientific-Surgery |title=John Hunter: 'Founder of Scientific Surgery' |access-date=17 December 2012 |url-status=live |archive-url=https://web.archive.org/web/20131214210131/http://www.healio.com/hematology-oncology/news/print/hematology-oncology/%7Bc9a8ca57-fa27-4432-aadf-d8ee0671428f%7D/john-hunter-founder-of-scientific-surgery |archive-date=14 December 2013 |df=dmy-all }}</ref>
Other important 18th- and early 19th-century surgeons included [[Percival Pott]] (1713–1788) who described [[Pott disease|tuberculosis on the spine]] and first demonstrated that a cancer may be caused by an environmental [[carcinogen]] (he noticed a connection between [[chimney sweep]]'s exposure to soot and their high incidence of [[Chimney sweeps' carcinoma|scrotal cancer]]). [[Astley Paston Cooper]] (1768–1841) first performed a successful ligation of the abdominal aorta, and [[James Syme]] (1799–1870) pioneered the Symes Amputation for the [[ankle joint]] and successfully carried out the first [[Hemipelvectomy|hip disarticulation]].
Modern [[pain]] control through [[anesthesia]] was discovered in the mid-19th century. Before the advent of [[anesthesia]], surgery was a traumatically painful procedure and surgeons were encouraged to be as swift as possible to minimize patient [[suffering]].  This also meant that operations were largely restricted to [[amputation]]s and external growth removals. Beginning in the 1840s, surgery began to change dramatically in character with the discovery of effective and practical anaesthetic chemicals such as [[diethyl ether|ether]], first used by the American surgeon [[Crawford Long]], and [[chloroform]], discovered by Scottish obstetrician [[James Young Simpson]] and later pioneered by [[John Snow (physician)|John Snow]], physician to [[Queen Victoria]].<ref>{{cite book| vauthors = Gordon ML |title=Sir James Young Simpson and Chloroform (1811–1870) |url=https://books.google.com/books?id=pYer05UwKBYC|access-date=11 November 2011|year=2002|publisher=The Minerva Group, Inc. |isbn=978-1-4102-0291-8 |page=108}}</ref> In addition to relieving patient suffering, anaesthesia allowed more intricate operations in the internal regions of the human body.  In addition, the discovery of [[muscle relaxant]]s such as [[curare]] allowed for safer applications.{{citation needed|date=May 2023}}
====Infection and antisepsis====
The introduction of anesthetics encouraged more surgery, which inadvertently caused more dangerous patient post-operative infections. The concept of infection was unknown until relatively modern times. The first progress in combating infection was made in 1847 by the [[Hungarian people|Hungarian]] doctor [[Ignaz Semmelweis]] who noticed that medical students fresh from the dissecting room were causing excess maternal death compared to midwives. Semmelweis, despite ridicule and opposition, introduced compulsory handwashing for everyone entering the maternal wards and was rewarded with a plunge in maternal and fetal deaths; however, the [[Royal Society]] dismissed his advice.{{citation needed|date=May 2023}}
[[File:Joseph Lister2.jpg|thumb|upright|[[Joseph Lister, 1st Baron Lister|Joseph Lister]], pioneer of [[Antiseptic#Usage in surgery|antiseptic surgery]]]]
Until the pioneering work of British surgeon [[Joseph Lister, 1st Baron Lister|Joseph Lister]] in the 1860s, most medical men believed that chemical damage from exposures to bad air (see "[[Miasma theory of disease|miasma]]") was responsible for [[infections]] in wounds, and facilities for washing hands or a patient's [[wound]]s were not available.<ref name="storyof medicine">{{cite book | url=https://books.google.com/books?id=WKkCwqDEI9QC&q=%22good+old+surgical+stink%22&pg=PA420 | title=The Story of Medicine | publisher=Kessinger Publishing | vauthors=Robinson V | page=420 | isbn=978-1-4191-5431-7 | year=2005 }}{{Dead link|date=April 2023 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> Lister became aware of the work of French [[chemist]] [[Louis Pasteur]], who showed that rotting and [[fermentation (food)|fermentation]] could occur under [[Anaerobic infection|anaerobic conditions]] if [[micro-organisms]] were present.  Pasteur suggested three methods to eliminate the [[micro-organisms]] responsible for [[gangrene]]: filtration, exposure to heat, or exposure to [[chemical solutions]]. Lister confirmed Pasteur's conclusions with his own experiments and decided to use his findings to develop [[antiseptic]] techniques for wounds.  As the first two methods suggested by Pasteur were inappropriate for the treatment of human tissue, Lister experimented with the third, spraying [[carbolic acid]] on his instruments. He found that this remarkably reduced the incidence of gangrene and he published his results in ''[[The Lancet]]''.<ref>{{cite journal | vauthors = Lister J | title = On a new method of treating compound fracture, abscess, etc.: with observations on the conditions of suppuration. | journal = The Lancet | date = March 1867 | volume = 89 | issue = 2272 | pages = 326–329 | doi = 10.1016/S0140-6736(02)51192-2 }}<br>Five articles running from:<br>Volume 89, Issue 2272, 16 March 1867, pp. 326–29 (Originally published as Volume 1, Issue 2272)<br>
to:<br>Volume 90, Issue 2291, 27 July 1867, pp. 95–96 Originally published as Volume 2, Issue 2291</ref> Later, on 9 August 1867, he read a paper before the British Medical Association in Dublin, on the ''[[Antiseptic Principle of the Practice of Surgery]]'', which was reprinted in the ''British Medical Journal''.<ref>{{cite journal | vauthors = Lister J | title = On the Antiseptic Principle in the Practice of Surgery | journal = British Medical Journal | volume = 2 | issue = 351 | pages = 246–248 | date = September 1867 | pmid = 20744875 | pmc = 2310614 | doi = 10.1136/bmj.2.351.246 }}. Reprinted in {{cite journal | vauthors = Lister BJ | title = The classic: On the antiseptic principle in the practice of surgery. 1867 | journal = Clinical Orthopaedics and Related Research | volume = 468 | issue = 8 | pages = 2012–2016 | date = August 2010 | pmid = 20361283 | pmc = 2895849 | doi = 10.1007/s11999-010-1320-x }}</ref><ref name=FUSourcebook>{{cite web| vauthors = Lister J |title=Modern History Sourcebook: Joseph Lister (1827–1912): Antiseptic Principle Of The Practice Of Surgery, 1867|url=http://www.fordham.edu/halsall/mod/1867lister.asp|publisher=Fordham University|access-date=2 September 2011|url-status=live|archive-url=https://web.archive.org/web/20111107163352/http://www.fordham.edu/halsall/mod/1867lister.asp|archive-date=7 November 2011|df=dmy-all}}Modernized version of text</ref><ref name=PG-JL>{{Cite book| vauthors = Lister J |title=On the Antiseptic Principle of the Practice of Surgery by Baron Joseph Lister|url=http://www.gutenberg.org/ebooks/23968|publisher=Project Gutenberg|access-date=2 September 2011|url-status=live|archive-url=https://web.archive.org/web/20111009065204/http://www.gutenberg.org/ebooks/23968|archive-date=9 October 2011|df=dmy-all|date=December 2007}} E-text, audio at Project Gutenberg.</ref> His work was groundbreaking and laid the foundations for a rapid advance in infection control that saw modern antiseptic operating theatres widely used within 50 years.{{citation needed|date=May 2023}}
Lister continued to develop improved methods of [[antisepsis]] and [[asepsis]] when he realised that infection could be better avoided by preventing bacteria from getting into wounds in the first place. This led to the rise of sterile surgery. Lister introduced the Steam Steriliser to [[sterilization (microbiology)|sterilize]] equipment, instituted rigorous hand washing and later implemented the wearing of rubber gloves. These three crucial advances – the adoption of a scientific methodology toward surgical operations, the use of anaesthetic and the introduction of sterilised equipment – laid the groundwork for the modern invasive surgical techniques of today.
The use of [[X-rays]] as an important medical diagnostic tool began with their discovery in 1895 by German [[physicist]] [[Wilhelm Röntgen]]. He noticed that these rays could penetrate the skin, allowing the skeletal structure to be captured on a specially treated [[photographic plate]].
<gallery widths="200px" heights="200px">
Image:Acquapendente - Operationes chirurgicae, 1685 - 2984755.tif|[[Hieronymus Fabricius]], ''Operationes chirurgicae'', 1685
File:John Syng Dorsey.jpg|John Syng Dorsey wrote the first American textbook on surgery
File:1753 Traversi Operation anagoria.JPG| An operation in 1753, painted by [[Gaspare Traversi]].
</gallery>
== Surgical specialties ==
<!--[[Surgical specialties]], [[Surgery specialties]] and [[Specialties in surgery]] redirect here-->
{{div col|colwidth=30em}}
* [[General surgery]]
*: {{hlist <!--Alphabetical by linkname:--> }}
<!--Alphabetical:-->
* [[Breast surgery|Breast]]
* [[Cardiothoracic surgery|Cardiothoracic]]
* [[Colorectal surgery|Colorectal]]
* [[Craniofacial surgery]]
* [[Dental surgery]]
* [[Endocrine surgery|Endocrine]]
* [[Gynaecology]]
* [[Neurosurgery]]
* [[Ophthalmology]]
* [[Surgical oncology|Oncological]]
* [[Oral and maxillofacial surgery]]
* [[Organ transplantation|Transplant]]
* [[Orthopaedic surgery]]
* [[Hand surgery]]
* [[Otolaryngology]]
* [[Pediatric surgery|Paediatric (Pediatric)]]
* [[Periodontal surgery]]
* [[Plastic surgery|Plastic]]
* [[Podiatric surgery]]
* [[Skin surgery|Skin]]
* [[Trauma surgery|Trauma]]
* [[Urology]]
* [[Vascular surgery|Vascular]]
{{div col end}}
==Learned societies==
{{div col|colwidth=30em}}
* [[World Federation of Neurosurgical Societies]]
* [[American College of Surgeons]]
* [[American College of Osteopathic Surgeons]]
* [[American Academy of Orthopedic Surgeons]]
* [[American College of Foot and Ankle Surgeons]]
* [[Royal Australasian College of Surgeons]]
* [[Royal Australasian College of Dental Surgeons]]
* [[Royal College of Physicians and Surgeons of Canada]]
* [[Royal College of Surgeons in Ireland]]
* [[Royal College of Surgeons of Edinburgh]]
* [[Royal College of Physicians and Surgeons of Glasgow]]
* [[Royal College of Surgeons of England]]
{{div col end}}
== See also ==
{{Portal|Medicine}}
{{div col}}
* {{annotated link|Anesthesia}}
* {{annotated link|ASA physical status classification system}}
* {{annotated link|Biomaterial}}
* {{annotated link|Cardiac surgery}}
* {{annotated link|Current Procedural Terminology|abbreviation=CPT}} – for [[outpatient]] surgical procedures [[medical coding]]
* {{annotated link|Drain (surgery)|Surgical drain}}
* {{annotated link|Endoscopy}}
* {{annotated link|Fluorescence image-guided surgery}}
* {{annotated link|Hypnosurgery}}
* {{annotated link|Healthcare Cost and Utilization Project|abbreviation=HCUP}} – a family of health care databases etc. from the US
* {{annotated link|ICD-10 Procedure Coding System}} ([[International Classification of Diseases]], 10th edition, Procedural Coding System; [[inpatient]] surgical procedures medical coding)
* {{annotated link|Jet ventilation}}
* [[List of surgical procedures]]
* {{annotated link|Minimally invasive surgery#Minimally invasive procedure|Minimally invasive procedure}}
* {{annotated link|Operative report}}
* {{annotated link|Perioperative mortality}}
* {{annotated link|Physician Assistant}}
* {{annotated link|Remote surgery}}
* {{annotated link|Robot-assisted surgery}}
* {{annotated link|Surgeon's assistant}}
* {{annotated link|Surgical Outcomes Analysis and Research}}
* {{annotated link|Surgical sieve}}
* {{annotated link|Trauma surgery}}
* {{annotated link|Reconstructive surgery}}
* {{annotated link|Rheumasurgery}}
* {{annotated link|WHO Surgical Safety Checklist}}
* [[Women in medicine]]
{{div col end}}
=== List of Surgery-related fields ===
{{div col}}
* [[Bariatric surgery]]
* [[Cardiac surgery]]
* [[Cardiothoracic surgery]]
* [[Colorectal surgery]]
* [[Endocrine surgery]]
* [[Ophthalmology]]
* [[General surgery]]
* [[Neurosurgery]]
* [[Oral and maxillofacial surgery]]
* [[Orthopedic surgery]]
* [[Hand surgery]]
* [[Otorhinolaryngology|Otolaryngology]]
* [[Pediatric surgery]]
* [[Plastic surgery]]
* [[Reproductive surgery]]
* [[Surgical oncology]]
* [[Organ transplantation|Transplant surgery]]
* [[Trauma surgery]]
* [[Urology]]
** [[Andrology]]
* [[Vascular surgery]]
{{div col end}}
== Notes ==
{{Notelist}}
== References ==
{{Reflist}}
{{Sister project links}}
== Further reading ==
* [https://doi.org/10.2340/16501977-2269 Bartolo, M., Bargellesi, S., Castioni, C. A., Intiso, D., Fontana, A., Copetti, M., Scarponi, F.,  Bonaiuti, D., & Intensive Care and Neurorehabilitation Italian Study Group (2017). Mobilization in early rehabilitation in intensive care unit patients with severe acquired brain injury: An observational study. Journal of rehabilitation medicine, 49(9), 715–722.]
* [https://doi.org/10.1016/j.ijsu.2018.04.060 Ni, C.-yan, Wang, Z.-hong, Huang, Z.-ping, Zhou, H., Fu, L.-juan, Cai, H., Huang,   X.-xuan, Yang, Y., Li, H.-fen, & Zhou, W.-ping. (2018). Early enforced mobilization after liver resection: A prospective randomized controlled trial. International Journal of Surgery, 54, 254–258.]
* [https://doi.org/10.1186/s40779-021-00310-x Lei, Y. T., Xie, J. W., Huang, Q., Huang, W., & Pei, F. X. (2021). Benefits of early   ambulation within 24 h after total knee arthroplasty: a multicenter retrospective cohort study in China. Military Medical Research, 8(1), 17.]
* [https://doi.org/10.21037/jgo.2017.11.05 Stethen, T. W., Ghazi, Y. A., Heidel, R. E., Daley, B. J., Barnes, L., Patterson, D., &   McLoughlin, J. M. (2018). Walking to recovery: the effects of missed ambulation events on postsurgical recovery after bowel resection. Journal of gastrointestinal oncology, 9(5), 953–961.]
* [https://doi.org/10.21037/atm.2019.02.02 Yakkanti, R. R., Miller, A. J., Smith, L. S., Feher, A. W., Mont, M. A., & Malkani, A. L. (2019).   Impact of early mobilization on length of stay after primary total knee arthroplasty. Annals of translational medicine, 7(4), 69.]
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{{Surgery}}
{{Authority control}}
[[Category:Surgery| ]]