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Introduction to routine postoperative care

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Infected post-operative wound on the abdomen of a 75-year-old woman 1 week after surgery. Dr P Marazzi / Science Photo Library.

The care of the gynaecological patient in the postoperative period has changed dramatically in the last generation. Previously it was routine for women to remain in hospital on bed rest for up to two weeks following a hysterectomy; there are now units who routinely perform laparoscopic hysterectomies as day cases!

These changes have been driven by a number of factors, including a realisation of the dangers of a prolonged hospital stay with increased risks of infective and thromboembolic complications.

In addition to these evidence-driven clinical reasons for the change, in practice there has been a profound shift in the social and economic factors surrounding patient stay. Pressures on hospital beds and funding have driven down length of stay. These pressures are formalised in the development of 'managed care' led by insurance suppliers in the USA. In this system, all the steps in the patient's journey have been scrutinised and efficiency maximised so that postoperative patients remain in hospital for the minimum time. This system was driven by economic needs but has potential advantages for the patient as long as patient care is central to the development of the care programme, and sufficient flexibility is retained to recognise that each woman and her needs are unique and, therefore, that her postoperative care will need to be specific to those needs.

This tutorial explores the evidence surrounding some of the major components to postoperative care, whilst not considering the treatment of pre- or postoperative complications.

Learning objectives

When you have completed this tutorial you will:

  • be aware of the major issues around the care of the postoperative patient
  • have an understanding of the fluid and electrolyte requirements of the postoperative woman
  • be able to manage the routine bladder and drain needs postoperatively
  • be able to assess risk of, and prophylaxis against, thromboembolic disease
  • have an understanding of the importance of prevention of infection postoperatively

Last updated: 10/08/10 (tutorial reviewed and updated by Dr Wendy Noble)

22/01/10 (image showing the Intravascular fluid depletion replaced with a new, higher quality version)

1/07/09 (WHO surgery checklist added in 'Preliminary reading')

16/01/09 (link to a NEJM paper on the use of a surgical safety checklist added in the 'Preliminary reading' section).

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