Evidence-Based Perioperative Care

Preoperative Phase

The American Society of Anesthesiologists recommends conducting early assessment and optimization of the patient's condition, tailoring the approach based on available time before surgery 2
Patient education should be provided in oral, written, and/or pictorial formats to both the patient and a relative/caregiver, as suggested by the World Journal of Emergency Surgery 3
Screening for modifiable risk factors, including smoking, alcohol use, undiagnosed hypertension, diabetes, anemia, and nutritional status, is crucial in the preoperative phase 3
Multimodal intervention strategies should be implemented to prevent postoperative delirium, especially in elderly or high-risk patients, according to Anaesthesia 1, 4

The World Health Organization's Surgical Safety Checklist should be applied to ensure standardized safety protocols 5
Maintaining core temperature at ≥36°C through active warming for operations lasting longer than 30 minutes is recommended by the World Journal of Emergency Surgery 3
Opioid-sparing analgesia techniques combined with local and regional blocks should be implemented when appropriate, as suggested by the British Journal of Anaesthesia 6
Minimally invasive surgical approaches should be advocated for when resources and expertise are available, according to the World Journal of Emergency Surgery 3

Early oral feeding, with fluids as soon as the patient is lucid and solids after 4 hours, should be facilitated, as recommended by the World Journal of Emergency Surgery 3
Promoting early mobilization, with 30 minutes on the day of surgery and 6 hours/day thereafter, is crucial for patient recovery 3
Multimodal opioid-sparing analgesia using combinations of paracetamol and NSAIDs, with opioids as last resort and in low doses, should be administered, according to the British Journal of Anaesthesia 6
Urinary catheters should be removed within 24 hours after surgery for most patients, as suggested by the World Journal of Emergency Surgery 3

For elderly patients, it should be assumed that they have the mental capacity to make decisions about their treatment unless clearly demonstrated otherwise, according to Anaesthesia 1, 4
Continuity of care should be maintained through reciprocal information flow between patients, relatives/carers, and primary and secondary care services, as recommended by Anaesthesia 2
Elderly patients are at higher risk for postoperative delirium, and preventive measures should be implemented, according to Anaesthesia 1, 4
Pain management should be addressed proactively, especially in cognitively impaired patients who may not effectively communicate pain, as suggested by Anaesthesia 1, 4

Failing to recognize cognitive impairment can be avoided by using standardized screening tools to identify at-risk patients, according to Anaesthesia 1
Inadequate pain management can be prevented by implementing multimodal analgesia and regular pain assessments, as recommended by the British Journal of Anaesthesia 6
Poor communication during care transitions can be avoided by ensuring comprehensive handover between care settings, according to the International Journal of Nursing Studies 10
Inconsistent application of evidence-based practices can be prevented by using standardized protocols and checklists, as suggested by the World Journal of Emergency Surgery and the International Journal of Nursing Studies 3, 10