Principles of operative surgery

Abstract The operating theatre is a complex environment for which the risk of adverse events should be minimized. Correct perioperative procedures include: providing informed consent; detailed planning of the procedure, including anticipating possible deviations from the expected; routine use of the World Health Organization Surgical Safety Checklist; supervision of patient positioning; safe use of local anaesthesia, diathermy, and radiation; and having the knowledge and technical skills appropriate for the operation planned. The surgeon must be aware that human factors (communication and interaction, situational awareness and vigilance, cooperation and team skills, leadership and managerial skills) can affect safety in the operating theatre. Post-operative care includes assessment of the general appearance of the patient, use of a Paediatric Early Warning Score (PEWS), monitoring pain and analgesia, and urine output, intravenous fluids, medication, nutrition, mobilization, and accurate documentation of decisions. All surgeons should be fully aware of their own clinical outcomes and constantly strive to improve the quality of their service. This includes reflecting on their practice, commitment to audit, and attending morbidity and mortality meetings.