Surgeon: surgical treatment

A surgeon is a physician who diagnoses diseases, injuries, and developmental abnormalities and treats them surgically, restoring organ and tissue function, reducing pain, and improving quality of life. Modern surgery encompasses a wide range of specialties, from general abdominal and colorectal surgery to cardiovascular, thoracic, neurosurgery, orthopedics, urology, plastic surgery, and surgical oncology. The choice of approach is based on evidence, interdisciplinary collaboration, and patient consent after an explanation of the risks and alternatives. [1]

Surgical training includes basic medical training, internship, stages of basic surgical training, and subsequent specialization. Professional colleges and councils establish competency standards, examinations at various stages, and requirements for continuing education, which support the quality and safety of care. For patients, this means a predictable level of skill and adherence to clinical protocols at all stages of treatment. [2]

The surgeon's role has long expanded beyond the operating room. They plan treatment in collaboration with anesthesiologists, therapists, and rehabilitation specialists, conduct preoperative risk assessments, prepare the patient for surgery using enhanced recovery protocols, and then oversee pain management, complication prevention, and rehabilitation. This approach reduces the length of hospital stay and increases satisfaction with treatment. [3]

Surgical practice is rapidly changing thanks to minimally invasive techniques and robotic assistance, digital planning, safety standards, and complication prevention. However, even the most advanced technologies are being incorporated only where they improve outcomes without unjustifiably increasing risks and costs. The balance between effectiveness, safety, and accessibility remains the primary selection criterion. [4]

Table 1. Surgical specialties: examples

Direction	Examples of areas of responsibility
General surgery	abdominal organs, soft tissues
Colorectal surgery	colon and rectum, pelvic floor
Cardiovascular and thoracic surgery	heart, large vessels, lungs
Neurosurgery	brain and spinal cord, nerves
Orthopedics and traumatology	bones, joints, tendons
Urology	organs of the urinary and male reproductive systems
Plastic and reconstructive	restoration of form and function
Judicially recognized subspecialties	surgical oncology, vascular, pediatric and others

Based on lists of professional organizations. [5]

When should you see a surgeon?

Indications for consultation include acute conditions such as abdominal pain with suspected acute appendicitis, strangulated hernias, acute trauma, and bleeding, as well as elective situations such as gallstones, non-strangulated hernias, tumors, chronic inflammatory processes, and benign skin and soft tissue lesions. Early consultation allows for risk assessment, selection of the scope of examination, and determination of whether surgery is necessary or conservative management is feasible. [6]

In patients with multiple trauma, a "damage control" approach is used, which involves first performing brief life-saving interventions to control bleeding and limit contamination, followed by intensive stabilization, and only then proceeding to definitive reconstruction. This staged approach reduces mortality by preventing worsening coagulopathy and shock. Decisions are made according to trauma service protocols. [7]

Patients with significant comorbidities are singled out for special consideration; surgical tactics are always balanced against the overall benefit, life expectancy, and the individual's priorities. Current guidelines emphasize the importance of shared decision-making, including discussion of palliative options if radical surgery does not improve the prognosis and quality of life. [8]

Finally, the surgeon also plays a role in preventing complications of chronic diseases, such as diabetic foot ulcers with a risk of bleeding, and vascular lesions with a risk of tissue ischemia. Timely referral and a team approach reduce the likelihood of amputations, severe bleeding, and sepsis, and shorten recovery time. [9]

Table 2. Typical reasons for referral to a surgeon

Situation	What does a surgeon do?	Expected target
Acute abdomen, strangulated hernia	emergency surgery or observation according to clear criteria	eliminating the cause, preventing necrosis
Symptomatic cholelithiasis	laparoscopic cholecystectomy according to indications	reduction of pain and risk of complications
Tumors	staging and oncosurgical treatment in a team	disease control, radicality
Chronic hernias and defects	planned restoration of the anterior abdominal wall	improving function and quality of life

Generalized according to the tasks of the specialized areas. [10]

How the patient's journey works: before, during, and after surgery

The preoperative phase begins with a risk assessment, including functional status scales, medication review, and comorbidities, as well as an explanation of the procedure and alternatives. All patients are recommended to follow the World Health Organization safety checklist, which structures key checks before anesthesia, before incision, and before leaving the operating room. This reduces the likelihood of errors, improves team communication, and enhances safety. [11]

Modern approaches to fasting before elective anesthesia include more flexible guidelines: clear liquids are allowed up to 2 hours before induction, light foods are generally stopped 6 hours before, and carbohydrate drinks are permitted in selected patients according to the 2023 modular update. Separate clarifications apply for children and high-risk groups. These measures reduce discomfort and may improve recovery without increasing the risk of aspiration when protocols are followed. [12]

The intraoperative phase is structured according to the principles of accelerated recovery protocols. These include multimodal pain management, maintaining normothermia, limited infusion therapy, appropriate prevention of nausea and vomiting, and early mobilization. Systematizing the phases in the form of checklists improves predictability, reduces the incidence of complications, and reduces the length of hospital stay. [13]

The postoperative phase focuses on early nutrition, adequate pain relief, thrombosis and infection prevention, glycemic control, drainage and suture management, and patient education. Multimodal pain management combined with unfractionated or low-molecular-weight anticoagulants, when indicated, facilitates a safe return to activity and reduces the risk of readmission. [14]

Table 3. Stages of surgical care and checkpoints

Stage	Main tasks	Key quality tools
Before surgery	risk assessment, preparation, plan	World Health Organization checklist, accelerated recovery protocols
During the operation	technique, anesthesia, prevention of complications	standardized anesthetic and surgical protocols
After surgery	pain relief, early activation, monitoring	multimodal analgesia, prevention of thrombosis and infections

Based on the Safety and Recovery Guidelines.[15]

Prevention of complications: infections, thrombosis, blood loss, pain

Prevention of surgical site infections relies on several components: optimized skin preparation, maintaining normothermia, glycemic control, appropriate fluid therapy, and meticulous sterility. Timely antibiotic prophylaxis plays a key role, with the choice depending on the type of surgery, local resistance, and patient characteristics. Continuous monitoring of these parameters helps adjust tactics in real time. [16]

Antibiotic prophylaxis is prescribed for a limited period before incision and is not unnecessarily prolonged after surgery. Basic international recommendations are supplemented by European guidelines for patients colonized with multidrug-resistant gram-negative bacteria, which take into account high-risk factors and colonization potential. The goal is sufficient exposure at the time of incision while minimizing side effects and resistance selection. [17]

Prevention of venous thromboembolism combines mechanical and pharmacological approaches depending on the risk profile and type of intervention. Current hematology guidelines formulate stratification by procedures and patient conditions and offer dosing and duration options, including extended regimens in selected groups. Individualization of choice reduces complications without excessive bleeding. [18]

Blood loss management is based on the principles of programmatic blood management, which includes preoperative correction of iron deficiency and anemia, limiting unnecessary transfusions, blood-saving techniques, and interdisciplinary protocols. The World Health Organization's 2025 global guidelines support the implementation of such programs at the institutional and regional levels, improving outcomes and the rational use of donor blood. [19]

Pain management has shifted toward multimodal regimens using combinations of non-narcotic and regional techniques, which reduces the need for opioids and side effects. Interdisciplinary consensus documents in recent years emphasize the importance of preoperative pain management planning, precise titration, and clear criteria for transitioning to home care. This improves the tolerability of early arousal and self-care. [20]

Table 4. Preoperative nutrition and fasting

Paragraph	Practical guideline
Clear drinks	allowed for up to 2 hours during planned anesthesia in selected patients
Light food	stops within 6 hours, heavy food - earlier by agreement
Carbohydrate drinks	possible with the 2023 modular update
Special groups	separate rules for children and high-risk patients

Based on the 2023 Preoperative Fasting Modular Update.[21]

Table 5. Prevention of infections in the surgical site

Component	Key actions
Patient preparation	skin care, glycemic control, smoking cessation
Antibiotic prophylaxis	pre-incision injection, risk adjustment
Intraoperative measures	maintaining normothermia, asepsis, sparing infusion
Postoperative stage	wound care, patient education, monitoring

Summarized from safety and surveillance documents. [22]

Table 6. Prevention of venous thromboembolism

Risk profile	Recommended measures
Short	early activation, mechanical means as indicated
Moderate	mechanical means, prophylactic doses of anticoagulants
High	combination prophylaxis and possible extension after discharge
Special situations	individualization by type of operation and associated factors

Summary of clinical guidelines for prophylaxis in surgical patients. [23]

Modern technologies and approaches

Minimally invasive techniques reduce tissue trauma, reduce pain, and accelerate return to activity with comparable oncological and functional efficacy across a wide range of procedures. The development of robotic assistance expands the capabilities of complex dissection in narrow anatomical spaces and standardizes technical steps. Regulatory decisions on new systems confirm the expansion of the technological base while maintaining safety criteria. [24]

Enhanced recovery protocols are a set of coordinated activities that cover the entire patient journey. They include counseling, nutritional support, optimization of anesthesia and fluid therapy, early nutrition, and mobilization. Specific updates are released for different types of surgeries, helping to tailor the template to the specific procedure and patient population. [25]

Digital planning of surgeries and rehabilitation relies on checklists, simulations, and interdisciplinary consultations. Recent publications emphasize the importance of not only technological but also organizational implementation factors: team training, performance audits, patient feedback, and continuous route adjustments. This allows for the effectiveness to be consolidated in real-world practice. [26]

The research agenda continues to address optimal intervals and criteria for staged strategies in severe trauma, as well as the fair cost assessment of high-tech interventions. Recent reviews highlight the need to individualize decisions based on the biology of the disease, risks, and patient priorities. [27]

Table 7. Principles of accelerated recovery after surgery

Block	Examples of events
Before surgery	training, nutrition and anemia optimization, modular fasting rules
During the operation	multimodal analgesia, controlled infusion, normothermia
After surgery	early nutrition and activation, prevention of nausea and vomiting
Quality	checklists, audits, team and patient training

Summary of documents from the Society for Accelerated Recovery and specialized reviews. [28]

Safety and informed consent

Surgical safety begins with team communication and confirmation of key parameters directly in the operating room. The World Health Organization's Universal Checklist structures patient identification, intervention clarification, blood loss risk assessment, allergy information, equipment readiness, and emergency plans. Implementing this standard reduces errors and complications and has long been the norm for quality care. [29]

Informed consent includes a discussion of expected benefits, risks, possible alternatives, the scope of rehabilitation, and recovery timeframes. It is important to explain what preventative measures will be used to prevent complications and the patient's role in the success of treatment. This enhances engagement, commitment, and facilitates decision-making aligned with the individual's values. [30]

Preoperative nutrition and fasting rules, pain management regimens, infection and thrombosis prevention plans, and action plans for any deviations from the expected course are discussed separately. Clear instructions for taking regular medications and scheduling follow-up visits reduce the risk of plan disruptions and rehospitalizations. Standardizing these conversations improves quality without bureaucratization. [31]

Finally, the patient receives a reminder of warning signs after discharge: increasing pain, increasing swelling and redness of the wound, high fever, shortness of breath, bleeding, persistent vomiting, and urinary retention. Promptly seeking help for these symptoms significantly reduces the severity of complications and improves the prognosis. This forms the basis for safe postoperative care. [32]