Over 16 million inpatient operations are performed every year at hospitals in Germany alone. Numerous outpatient operations are done in doctor’s offices too. The most common procedures involve joints like the hip, knee or shoulder, and internal organs such as the stomach, gallbladder, uterus (womb) or bowel.
Exactly what a certain type of operation involves will depend very much on the specific situation: It might be quick and easy to do in one patient, and difficult and risky in another. Some operations can be done using just local anesthesia, whereas others require a general anesthetic. Surgery is often one treatment option among several – and sometimes it is the only option. Some operations can save your life, whereas others may not be needed.
But all kinds of surgery have one thing in common: Most people would rather avoid them altogether – they may be nervous or even afraid to “go under the knife.” For this reason, many of them want to know as much as possible about the chances of success and possible risks related to their upcoming surgery. That includes finding out about things like the best way to cope with anxiety before surgery and relieving pain afterwards.
Whether or not surgery is successful depends on more than just the procedure itself: Careful preparation and good follow-up care are often critical for the long-term success of an operation, and patients themselves also need to be actively involved.
The kind of preparations that need to be made will depend on things like the type of surgery, your overall health and your age. In medical emergencies, there's often no time to prepare for surgery.
When preparing for big operations, a lot of tests and examinations may have to be carried out in a hospital or a doctor's practice beforehand. In most cases, though, it's usually enough to arrive at the hospital shortly before the operation.
Before surgery, the doctor will describe what will be done during the operation and what else it involves. The chances of success and the associated risks should also be discussed during this talk. Other topics to be covered include the possible consequences of surgery (e.g. pain), what needs to be done after the operation, and how long you will be unable to work. You will also speak to an anesthesiologist before the operation. It can be helpful to write down a list of questions to take along to the appointment. Apart from in medical emergencies, a pre-surgery consultation like this has to take place before surgery is performed. After the pre-surgery consultation, you are asked to sign a declaration to confirm that the doctors have told you about the operation and associated risks, and that you agree to go ahead with the operation.
To prepare for the pre-surgery consultation, it is a good idea to write a list of all of the questions you still have about the surgery. Do not hesitate to bring up any worries and concerns you may have. Logistical issues can be clarified too – such as how to get home after outpatient surgery, and who will accompany you.
When do you have to stop eating and drinking before having a general anesthetic?
Children and adults usually have to stop eating six hours before having a general anesthetic, and stop drinking two hours beforehand. Babies generally aren't allowed to be (breast)fed within the last four hours before surgery.
Are you given medication before surgery?
People are usually given medication before surgery in order to prepare for the anesthetic. The medication may, for instance, help to calm your nerves or stop the production of saliva (spit) or stomach acid.
The surgical procedure
In hospitals, people who have big operations are first taken to a preparation area near the operating room. The anesthetic is usually prepared and given in the preparation area. It is needed in order to prevent the patient from feeling any pain during the operation. There are three different types of anesthetic:
- Local anesthesia is used to numb small areas, typically on the surface of the body, for minor operations.
- Regional anesthesia is used to numb larger areas of the body such as an arm, leg or the lower half of your body.
- General anesthesia is used in more major surgery, or if the person can't or doesn't wish to have local or regional anesthesia. When people have this kind of anesthesia, they become unconscious, can't feel anything, and can't remember anything about the operation afterwards. General anesthesia may also be used in children or in adults who are very afraid of having the operation.
When operations are done under general anesthesia in a hospital, the surgeons are assisted by surgical nurses and other medical professionals. An anesthesiologist (anesthesia doctor) monitors the patient's circulation, heart function and breathing throughout the whole operation. To do so, the patient is hooked up to special equipment, including a breathing aid in people who are under general anesthesia.
The risks associated with an operation depend very much on the type of procedure, as well as the patient’s age and medical history. The surgeon’s level of experience plays a role too. Every anesthetic is associated with a risk of complications such as a sudden drop or increase in blood pressure or heart rate. Side effects are more common when general anesthesia is used than during regional or local anesthesia. But anesthetics only very rarely cause serious problems nowadays.
In hospitals, patients who have had a general anesthetic are taken to a recovery room once the operation is over. There they are cared for and monitored by special "perianesthesia" nurses and doctors, before being taken back to their ward. Their pulse, blood pressure and heart activity is monitored using equipment.
The most common side effects straight after surgery include drowsiness, nausea, dizziness and weakness caused by the general anesthetic, as well as pain due to the procedure. It is essential that you let the medical staff know if you have these kinds of problems after the operation so that they can be treated properly. If you have severe pain, for instance, it can slow down your recovery time. These side effects and other problems after the operation can generally be treated well with medication.
If you have had surgery in your abdominal (belly) area, you will usually not be allowed to eat anything until your digestive system starts up again. After other operations, you can eat and drink again as soon as the effects of the anesthetic have worn off.
People who have had major surgery normally need to stay in the hospital for a few days afterwards. The main focus of treatment after surgery is allowing the wounds to heal properly so that you can get back on your feet again as quickly as possible. Nowadays, people are no longer advised to rest in bed for a long time after operations. Most patients are encouraged to start standing and walking again as soon as they can.
After minor procedures, people can often be picked up and taken home right after the anesthetic wears off.
Some operations are followed by rehabilitation, which may take several weeks and can be done in the hospital or in an outpatient setting. The aim of rehabilitation is to help rebuild your strength so you will be ready to return to your routine daily activities. Physiotherapy is often an important part of rehabilitation. The aim of physiotherapy is to, for instance, help get an operated joint moving again and strengthen the muscles.
Before starting any kind of treatment, doctors are obliged to provide patients with detailed and easy-to-understand information about the advantages and disadvantages of the treatment, as well as possible alternatives. In Germany, these rights are protected in laws covering patients’ rights.
There are also a wide variety of different services for personal advice and support if you become ill.
Bundesministerium für Gesundheit (BMG). Ratgeber Krankenhaus - Was Sie zum Thema Krankenhaus wissen sollten. August 2017.
Bundesministerium für Gesundheit (BMG), Bundesministerium der Justiz und für Verbraucherschutz (BMJV). Informiert und selbstbestimmt - Ratgeber für Patientenrechte.
Informationen des BDA. Die meistgestellten Fragen zur Allgemeinanästhesie.
Sawicki PT. Qualität der Gesundheitsversorgung in Deutschland. Ein randomisierter simultaner Sechs-Länder-Vergleich aus Patientensicht. Med Klin 2005; 100(11): 755-768.
Statistisches Bundesamt (Destatis). Fallpauschalenbezogene Krankenhausstatistik (DRG-Statistik): Operationen und Prozeduren der vollstationären Patientinnen und Patienten in Krankenhäusern (4-Steller). October 23, 2017.
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