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Surgery is a high-stakes journey for patients and anyone who loves or is providing care for an individual going into a surgical procedure.
The process begins well before the first incision, continues during the operation, and carries on long after a patient leaves the operating room.
Perioperative care: What it is and why it matters
Perioperative care matters because it sets the tone for a set of practices and guidelines that mitigate risk while an individual is being operated on. When surgery goes well, postoperative recovery in the post-anesthesia care unit (PACU) and at home should be straightforward.
For nurses, surgical support staff, and facility managers, understanding perioperative care, its meaning, and the best practices to follow is essential to providing safe, quality, and patient-centered care. Any healthcare worker could find themselves supporting a patient at some point in their perioperative journey.
Surgery is the one place where no one—neither the patient nor the doctor—wants surprises. Here’s how to stay informed about perioperative care and provide empathetic and compassionate care.
Understanding the phases of perioperative care
Perioperative care is often divided into three main phases:
- Preoperative
- Intraoperative
- Postoperative
Each phase requires coordination, vigilance, and communication among the healthcare team to ensure patient safety and optimal recovery.
The preoperative phase: Preparation and risk assessment
This phase begins the moment surgery is scheduled. It involves collecting and verifying information to reduce the risk of complications before the patient reaches the operating room.
- Assessment and evaluation: The preoperative team reviews the patient’s medical history, medications, allergies, and previous anesthesia experiences. Laboratory work and imaging may be ordered to assess organ function and readiness for surgery.
- Risk identification: Tools like the ASA Physical Status Classification and cardiac risk indices help identify patients who may need additional monitoring or specialist input.
- Patient preparation: Patient preparation includes fasting instructions, skin cleansing, and medication management (for example, adjusting anticoagulants).
- Patient education: Explaining what to expect can reduce patient anxiety and improve cooperation. Clear instructions about recovery, pain control, and mobility help set realistic expectations.
A structured preoperative checklist ensures no detail is missed—from confirming the surgical site and consent forms to ensuring equipment and implants are ready.
The intraoperative phase: Maintaining stability and safety
Once the patient enters the operating room, the focus shifts to maintaining physiological stability, sterility, and team coordination.
- Anesthesia and monitoring: The anesthesiologist or certified registered nurse anesthetist (CRNA) manages sedation, pain control, and airway safety while continuously monitoring vital signs.
- Aseptic technique: Infection prevention begins with proper surgical hand scrub, sterile field setup, and use of prophylactic antibiotics when indicated.
- Team communication: The “time-out” process—verifying the patient, procedure, and site before incision—is one of the most effective safety interventions.
- Intraoperative documentation: Detailed charting of times, medications, and events ensures continuity of care and accountability.
The intraoperative phase highlights the essence of teamwork: every role, from scrub tech to circulating nurse, contributes to a safe and efficient surgical experience.
The postoperative phase: Recovery and follow-up
After the final suture, attention turns to recovery, monitoring, and rehabilitation.
- Immediate recovery: In the post-anesthesia care unit (PACU), staff assess airway, breathing, circulation, and level of consciousness. Pain, nausea, and wound status are closely monitored.
- Transition of care: Communication during handoff to inpatient units (progressive care unit or medical-surgical unit), or home-care providers ensures continuity.
- Rehabilitation and education: Early mobilization, wound care, and discharge teaching all play vital roles in preventing complications and promoting independence.
Effective postoperative care shortens recovery time, minimizes readmissions, and supports long-term outcomes.
The perioperative care team and their roles
Perioperative care is inherently multidisciplinary. Successful outcomes depend on the collaboration of diverse professionals:
- Surgeons: Lead the procedure and oversee clinical decision-making.
- Anesthesiologists or CRNAs: Manage anesthesia and vital functions throughout surgery.
- Perioperative and PACU nurses: Provide hands-on patient monitoring, documentation, and support during every stage.
- Surgical technologists: Maintain sterile fields and prepare instruments.
- Certified nursing assistants and orderlies: Assist with patient positioning and transport.
- Facility and scheduling staff: Coordinate operating room time, equipment availability, and staffing.
Each member contributes to a culture of safety that relies on open communication and mutual trust.
Patient safety and quality in perioperative care
Perioperative safety protocols form the foundation of surgical excellence. They are guided by national standards such as the World Health Organization (WHO) Surgical Safety Checklist and the Association of periOperative Registered Nurses (AORN) guidelines.
Key safety protocols
- Surgical verification: Confirming patient identity, procedure, and site before anesthesia and incision
- Sterile practices: Consistent hand hygiene, proper gowning, and instrument sterilization
- Medication safety: Double-checking high-risk drugs such as anticoagulants, insulin, and narcotics
- Device and count verification: Preventing retained instruments or sponges through standardized counts
- Fire and electrical safety: Especially crucial in ORs using electrocautery or oxygen
Quality improvement and data tracking
Continuous improvement requires measurement. Facilities track postoperative complications, infection rates, and unplanned readmissions. Morbidity and mortality reviews identify learning opportunities.
Data dashboards and perioperative analytics help facilities benchmark their performance against national averages and implement targeted interventions.
Quality improvement isn’t a one-time project—it’s an ongoing commitment to patient safety and accountability.
Assessing and preventing risk: Key questions
Understanding and addressing potential risks throughout the perioperative period is essential to improving patient outcomes. Here are a few critical questions that help guide safer, more effective surgical care.
How do we assess and prevent persistent postsurgical pain (PPSP)?
Risk factors include unmanaged acute pain, certain surgical types, and psychological distress.
Multimodal pain management, regional anesthesia, and early mobility help prevent PPSP.
What are the risk factors for developing postoperative cognitive dysfunction (POCD)?
Older age, preexisting cognitive impairment, long surgeries, and inflammation are risk factors for POCD.
Preventive strategies include pre-op cognitive screening, delirium prevention, and minimizing deep anesthesia.
What are the risks of long-term opioid use following surgery?
Long-term opioid use post-surgery can lead to dependence and chronic pain. Clinicians should use multimodal approaches and educate patients on tapering.
How do outcomes-based surgical quality programs (like NSQIP) influence long-term care?
They provide benchmarks and drive improvements in protocol adherence, complication reduction, and resource planning.
Collaboration between clinicians and facility leaders is essential to implement changes based on this data.
Technology and innovation in perioperative care
Modern perioperative care extends beyond the operating room. Technology now integrates patient data, communication, and scheduling systems to reduce errors and streamline workflows.
- Electronic health records (EHRs): Allow seamless sharing of surgical checklists, consent forms, and anesthesia notes.
- Smart monitoring systems: Provide real-time alerts for changes in vitals or fluid balance.
- AI and automation: Assists with risk prediction, workflow optimization, and early detection of complications by analyzing patient data and surgical metrics in real time.
- Robotic and minimally invasive surgery: Shortens operative time, reduces blood loss, and speeds recovery.
- Predictive analytics: Uses large datasets to identify patients at risk of complications before they occur.
When used responsibly, these innovations enhance—not replace—the human connection that defines safe surgical care.
Challenges in delivering effective perioperative care
Even the best-equipped hospitals face barriers to consistent perioperative quality.
- Staffing shortages: Skilled perioperative nurses and surgical technologists are in high demand nationwide. Vacancies can increase stress and turnover.
- Communication breakdowns: Poor handoffs or incomplete documentation remain common causes of preventable harm.
- Resource limitations: Smaller or rural facilities may lack specialized equipment or access to certain surgical subspecialties.
- Patient factors: Complex comorbidities, language barriers, and socioeconomic challenges can affect preparation and recovery.
Addressing these challenges requires investment in workforce development and standardized training that ensures continuity of care even under pressure.
Strategies to improve perioperative outcomes
Quality perioperative care depends on consistent protocols, skilled professionals, and patient-centered teamwork. Facilities can adopt several strategies to improve outcomes.
Standardized protocols and checklists
Enhanced Recovery After Surgery (ERAS) pathways provide evidence-based guidance for pain control, fluid management, and nutrition. Standardizing these practices reduces variability and improves predictability.
Education and simulation
Training programs and simulation labs allow surgical teams to practice rare scenarios—such as malignant hyperthermia or massive hemorrhage—in a controlled environment.
Ongoing education keeps clinicians current with evolving standards and technologies.
A well-supported perioperative workforce is the cornerstone of patient safety.
Frequently asked questions about perioperative care
What are the three phases of perioperative care?
The three phases are preoperative (before surgery), intraoperative (during surgery), and postoperative (after surgery). Each phase has distinct goals and responsibilities to ensure patient safety.
Why is perioperative care important for patient outcomes?
Effective perioperative care reduces surgical complications, shortens hospital stays, and supports faster recovery by integrating planning, teamwork, and continuous monitoring.
Who are the members of the perioperative care team?
The team may include surgeons, anesthesiologists, nurses, surgical technologists, and support staff who collaborate throughout the patient’s surgical journey.
What are the best practices for perioperative patient safety?
Following surgical safety checklists, maintaining clear communication, verifying equipment and medications, and adhering to sterile technique are key to safe outcomes.
How can facilities improve their perioperative care pathways?
Investing in staff training, using standardized ERAS protocols, adopting technology for scheduling and documentation, and encouraging multidisciplinary collaboration are proven strategies.
Building a culture of safety and support
Perioperative care is more than a sequence of clinical tasks—it’s a philosophy of safety, precision, and compassion that spans every moment of a patient’s surgical experience.
When teams communicate, follow evidence-based practices, and adapt to challenges together, patients recover faster, complications decline, and satisfaction rises across the board.
Every member of the perioperative team, from the circulating nurse to the facility scheduler, plays a vital part in creating a safer surgical environment. By embracing innovation, collaboration, and patient-centered communication, healthcare organizations can ensure that every surgery begins and ends with trust, teamwork, and quality care.
