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Many medical conditions can affect recovery from surgery. It is important to make sure any known conditions are controlled as well as possible ahead of your surgery.

You can also book in for a general health check at your GP surgery if you are between 40 and 74 years old.

Diabetes

Good control of your blood sugar is really important to reduce your risk of infections after surgery. Think about your diet and weight. Talk to your diabetes nurse or team early to see if they need to make any changes to your treatment.

Blood pressure

Blood pressure should be controlled to safe levels to reduce your risk of stroke. Sometimes operations may be delayed if it is too high.

Have your blood pressure checked at your surgery well ahead of your operation – some GP surgeries have automated machines so you can pop in any time. If it is high, your GP can check your medications and make any changes needed ahead of the operation.

Anaemia (low blood count)

If you have been bleeding or have a chronic medical condition, a blood test can check whether you are anaemic. If you are, you should talk to your GP about treatment to improve your blood count before surgery.

Treating your anaemia before surgery reduces the chance of you needing a blood transfusion. It will also help your recovery and make you feel less tired after your surgery.

Heart, lung and other medical problems

If you have any other long-term medical problems, consider asking your GP or nurse for a review of your medications, especially if you think your health is not as good as it could be.

Anxiety and mental health

Most people feel some anxiety about having surgery. If the thought of going into hospital is making you very anxious or upset, it may be helpful to talk about your concerns with your GP. In some areas GPs can refer you for specific support.

Many techniques including mindfulness, relaxation and breathing exercises or yoga could help you relax before and after your surgery.

If you are taking medication for mental health problems it is important to let the nurse at the hospital know about your medication. They will usually not want you to stop this. They can help organise any particular support you need for your time in hospital or return home.

Dental health

If you have loose teeth or crowns, a visit to the dentist may reduce the risk of damage to your teeth during an operation.

We know that coming into hospital for surgery can be a worrying time. Talk to your family and friends about going into hospital and tell them how they can help you. Don’t underestimate how tired you may be afterwards.

Give the below checklist some thought well in advance of the operation.

• How will I pass the time? Have some headphones and music, books, tablet computer or puzzles.  Don’t forget chargers.

• What can I do to relax? Learn some breathing techniques, try yoga or listen to relaxing music. Read about mindfulness.

• What do I need to prepare at home? You may find it difficult to move around when you return from hospital – consider sleeping on the ground floor and getting mobility aids.

• Who can look after my elderly relatives? If friends and family cannot help, contact your local council and your local carer service.

• How will I get to and from the hospital? Can someone drive you? If you are eligible for hospital transport, the hospital may be  able to organise transport for you.

• Do I have enough easy-to-cook meals and healthy snacks for when I get home?  Think who might be able to help prepare meals or help with your shopping afterwards.

• Who can look after my children or pets? Don’t underestimate how tired you might feel after the operation. Ask friends and family to help or to be on standby. To help you with childcare, they may need to arrange time off work too. If you have significant difficulties looking after your children following an operation, talk to your local council or your health visitor.

• Do I have enough medication and batteries for my hearing aid to last me in hospital and when I get home? Remember to take your usual medication into hospital with you.

• Do I have some over-the-counter painkillers at home? You may need to take some during your recovery as instructed by the hospital.

• What do I need to pack? If you are staying in hospital overnight you should think about toiletries, nightwear and comfortable clothes and footwear. It is important to get out of bed, get dressed and start to move as soon as your operation allows – those who do this get home sooner and recover quicker. Temperatures in hospital can vary so some layers of clothing can be useful. See NHS Choices for further information.

• What else would be helpful to do? Get your house and garden in order. Get up to date with your general affairs and finances. This will mean you do not have to worry about these whilst you recover. 

• Whom should I let know I am going into hospital? Friends and family can usually give you practical support. It is also good to have people to talk with whilst you are at home recovering. Many people will want to help your recovery, so let them know how they can help in plenty of time. 

• Make sure I have a shower/bath before going to hospital to minimise the risk of infection.

Members of the perioperative team at the hospital will discuss your anaesthetic, surgery and recovery period. They will discuss any particular risks you have from both your anaesthetic and surgery and any choices you have. They will give you information to read at home. There will be a

contact number to ring if you need to ask more questions.

The better prepared you are, the easier the process is likely to be.

Below are some questions that you might want to ask the perioperative  team.

• What time do I need to stop eating and drinking before surgery?
• What medication should I take on the day of my surgery?
• What do I need to pack for the hospital?
• Do I need to remove nail varnish, gels or piercings?
• Can I have visitors? When are the visiting times?
• Will someone at the hospital shave me if needed before my surgery?
• When can I expect to go home?
• What help can I expect to need at home afterwards?
• How long will it be before I can shower/bathe again?
• Are there any important ‘dos’ and don’ts’ for my recovery?
• Will I have stitches or staples that need to be taken out?
• How much time will I need to arrange off work?
• Who will give me a fit/sick note for my employer?
• Will I have a check up afterwards?
• How long might it be before I can walk/swim/play golf/run again?
• When can I drive afterwards?
• How long will it be before my life is roughly back to normal?

Before you go home your nurse will give you written information about what to expect during your recovery and how to manage any pain you might  experience. This will also include anything to look out for and a number to call if you are worried.

The Royal College of Anaesthetists has released factsheets on some of the most common surgical operations to give more detailed information on how to prepare for different types of surgery and what to expect afterwards.

Before you go home your nurse will tell you

• any dos and don'ts
• whom to contact if worried
• what to look out for
• how to manage pain
• when to take your medication

Depending on what surgery you are having, recovery may take many weeks.

Don’t worry if some days go better than others, as this is normal. It can be useful to keep a recovery diary which you can continue after you go home.

Try and get into a routine and get up in the morning at a regular time. A list of daily goals can give structure to your day and help monitor your progress.

Visits and phone calls from family and friends can cheer you up and encourage you to reach your goals. Be careful though that you don’t tire yourself out from too many visitors.

Enhanced recovery is the name given to a programme that aims to get you back to your normal health as quickly as possible after a major operation. Hospital staff look at all the evidence of what you and they can do before, during and after your surgery to help give you the best chances for a quick and full recovery. This should get you home sooner.

The programmes will vary depending on what operation you are having and which hospital you are being treated at, but may include:

• improving your fitness levels before your operation if there is enough time
• treating any other long-term medical conditions
• reducing the time you are starved for by giving you water and carbohydrate drinks before your surgery
• giving you drugs to prevent sickness after surgery
• considering the best ways of giving pain relief during the operation
• using local anaesthetic blocks or regional anaesthetics where possible
• giving you the best pain relief afterwards to get you moving quicker
• allowing you to start drinking earlier
• reducing the time you have catheters and drips
• teaching you exercises to help you recover after your operation.

By following an enhanced recovery programme, there are usually fewer complications after surgery. There is also less chance of you needing to go back into hospital again.

Lead authors

Dr Hilary Swales, RCoA Patient Information Lead

Dr Anne-Marie Bougeard, RCoA Perioperative Medicine Fellow

Dr Ellie Walker, NIAA Health Services Research Centre (HSRC) Research Fellow 2014–2017

With contributions from

Dr David Paynton, Royal College of General Practitioners (RCGP) Clinical Lead for Commissioning

Mr Nick Markham, Royal College of Surgeons of England (RCS Eng) Council Member

Professor Ramani Moonesinghe, Director, NIAA Health Services Research Centre

Ms Elena Fabbrani, RCoA Patient Information Manager

This information has been reviewed by the RCoA Patient Information Group (which includes lay members) and by the RCoA Professional Standards Advisory Group.

Subtitle

Anaesthetists form the largest single hospital medical specialty and their skills are used in all aspects of patient care. Whilst the perioperative anaesthetic care of the surgical patient is the core of specialty work many anaesthetists have a much wider scope of practice.

This is a heading for a section here

The provision of sedation and anaesthesia for patients undergoing various procedures outside the operating theatre. Examples of this include different endoscopic procedures, interventional radiology and dental surgery (this list is not exclusive).

Anaesthetists scope of practice may include:

• The preoperative preparation of surgical patients
• The resuscitation and stabilisation of patients in the Emergency Department
• Pain relief in labour and obstetric anaesthesia
• Intensive care medicine
• Transport of acutely ill and injured patients:
  • Pre-hospital emergency care
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    • Pain medicine
    • Lorem ipsum

Around 10 million patients undergo surgery each year in the NHS

Any healthcare pathway catering for a population of this size must be simple, safe and efficient. However, problems arise when we identify individual patients on this pathway who have complex medical needs. This simple care pathway can then feel inflexible, as we attempt to address different medical problems for each patient we see.

Fortunately, the great majority of patients are well served by existing NHS surgery pathways. However, there is a growing body of evidence that the needs of the high-risk surgical patient are not being met. As a result, patients who are older or have significant medical problems are offered major surgery in a system that cannot adapt to minimise their risk of complications.

Around 250,000 high-risk patients undergo surgery each year in the NHS. This is approximately 15% of all those who need surgery as a hospital inpatient. We believe these patients need extra care to ensure they have the best possible recovery after surgery, but any solution to this problem must function well within the existing high volume NHS surgical service.

Traditionally, the care of patients undergoing major surgery has been tailored to the operation itself and the index disease being treated by the procedure. However, the majority of complications, which occur after surgery are not due to technical errors or failures by the surgical team, but are medical complications such as pneumonia or myocardial infarction. The prevention and treatment of these medical complications requires a broader approach than we currently take to the care of the surgical patient.

Unmet need

The scale of this unmet need is becoming increasingly clear, and with 10 million patients undergoing surgery each year in the NHS, even a low rate of avoidable harm will be associated with many preventable complications and deaths. The long-term impact of this short-term postoperative harm is also increasing.

Some surgical specialties have already made good progress in improving the quality of perioperative care. Cardiac surgery provides an excellent example of an efficient patient-centred care pathway led by a multi-disciplinary team, achieving better outcomes than many other types of major surgery. We need to take a similar approach for patients undergoing all forms of surgery. To achieve this, we need to define an integrated agenda for healthcare policy around the challenge of providing healthcare to patients undergoing major surgery.

We believe that perioperative care provides a solution to the unmet need, using existing skills and expertise within the NHS to reduce variation and improve patient outcomes after surgery.