Chapter 15: Surgery

The preoperative phase emphasizes systematic evaluation using standardized assessment tools such as the AMPLE mnemonic for emergency histories and the DRUGS mnemonic for complete medication reconciliation, alongside risk stratification for complications including cardiac events, anesthetic complications, and thromboembolism. Preventive measures for venous thromboembolism are highlighted, with discussion of pharmacologic prophylaxis agents such as heparin, enoxaparin, warfarin, and fondaparinux in high-risk populations. The chapter addresses intraoperative considerations including minimally invasive laparoscopic techniques that reduce tissue trauma and recovery time, with attention to maintaining hemodynamic stability and preventing iatrogenic complications. Trauma management follows the systematic primary and secondary survey approach, beginning with airway, breathing, and circulation assessment. Burn care receives detailed attention, including burn depth classification, calculation of total body surface area affected, fluid resuscitation protocols, and surgical interventions such as escharotomy for circumferential burns and fasciotomy for compartment syndrome relief. The postoperative period focuses on systematic complication surveillance using the Five Ws framework for fever evaluation, identifying wind infections, water-related infections, wound complications, walking-related thromboembolism, and medication-related adverse effects. The chapter covers management of common postoperative complications including wound infections treated with antimicrobial therapy and debridement, thromboembolism prevention through anticoagulation and early mobilization, and acute conditions such as wound evisceration requiring emergent surgical intervention. Nutritional support receives emphasis as a critical component of surgical care, particularly in critically ill patients requiring careful monitoring of caloric and nitrogen balance to support healing and immune function.