Operating Room Protocols: What Happens in the Surgery Room?

The operating room, or the OR, is where all the action happens during surgery. The OR is an important part of the hospital's infrastructure, and it has its own unique set of protocols that patients need to be aware of before entering the theater for their procedure.

This guide will help you navigate what happens in an operating room during an operation, from pre-op preparations through post-op recovery, to ensure that everything goes smoothly for patients and medical professionals.

What Is the Operating Room?

The operating room is where the surgery takes place. The surgeon operates on the patient in this sterile environment with minimal risk of infection to themselves or you as the patient.

The operating room has its own set of protocols that must be followed by everyone involved, from surgeons to nurses to anesthesiologists (doctors who administer anesthesia). This reduces the risk of infection, complications, and accidental injury.

Types of Operating Rooms

Operating rooms are generally one of three types: open, closed, or semi-closed.

An open operating room is the least sterile and most flexible environment. It allows for direct communication between staff members and patients, which may be beneficial in some situations but can also lead to infection transmission if precautions aren't taken.

A closed operating room is the most sterile environment. It allows for direct communication between staff members but not between them and patients. A semi-closed OR has an indirect barrier between staff members and patients, such as a curtain or a glass wall, which may allow for some infection transmission if precautions aren't taken.

Operating Theater Layout and Design

The layout of an OR depends on its size, but certain elements are common to all operating rooms.

  • The floor plan should be easy to clean and disinfect and resistant to stains and spills.
  • Surfaces should be made from materials that don't conduct electricity or heat efficiently; they must also be resistant to chemicals used during surgery.

Effective operating room management is critical for ensuring the success of any surgical procedure. From pre-operative planning to postoperative care, every step of the surgical process requires careful coordination and management to ensure optimal patient outcomes. Operating room management involves everything from scheduling and staffing to supply chain management and equipment maintenance.

By ensuring that all of these elements work together seamlessly, surgical teams can focus on providing the best possible care to their patients. Effective operating room management can also help reduce costs, improve efficiency, and enhance patient satisfaction, making it a priority for healthcare providers worldwide.

What are the Basic Principles to Follow in the Operating Room?

Here are some of the basic principles for operating room etiquette and safety that all practitioners should observe:

  1. Maintain Sterility: All surgical team members should keep a strict sterile environment. Scrubs, caps, masks, and gloves must be worn at all times. Before any procedure, thorough hand washing and proper gowning and gloving techniques are mandatory.
  2. Proper Patient Identification: Prior to the surgical process, patients must be correctly identified using at least two methods. This is critical in preventing wrong patient or wrong site surgeries, a major operating room fear.
  3. Communication: The surgical team must maintain clear and concise communication at all times. Precise briefings and debriefings are crucial; timeouts and checklists can be useful tools for verifying information.
  4. Safety: The whole team should work together to ensure the patient's safety by following standard precautions. This also includes careful handling of surgical instruments to prevent injuries.
  5. Respect for All: Respect for the patient and each professional in the operating room is fundamental. This creates a conducive working environment that aids in the patient’s recovery and well-being.
  6. Confidentiality: All patient health information should be kept confidential and should not be discussed outside the confines of the operating room.
  7. Stay aware of Time: Especially during long procedures, the team must take breaks to maintain peak performance.
  8. Solidify the Plan: All team members should understand the entire surgical plan, including the postoperative course.

Remember, these are just some foundational principles. More specific guidelines might be dictated by the healthcare facility or professional associations.

What Happens in Pre-Op the Day of Surgery?

The pre-operative phase, also known as "pre-op," is an important stage that occurs on the day of surgery. This stage involves several activities all geared toward preparing the patient for the surgical procedure:

  1. Health History Update: Prior to the surgery, the medical team will update the patient's health history. This information is vital as it helps dictate the necessary precautions and procedures that must be observed during surgery.
  2. Check Vital Signs: The clinical staff will check the patient's blood pressure, pulse, and temperature. Ensuring these are within normal range is crucial for the successful completion of any surgical operation.
  3. Meet with the Anesthesiologist: Where applicable, the patient will have a meeting with the anesthesiologist. The main purpose of this interview is to discuss and come up with the appropriate anesthesia care plan for the patient during and after the surgical operation.
  4. Patient Checkup: The patient will meet with one of their doctors for another checkup. This could be the surgeon or the primary care doctor. This checkup ensures that the patient is in the appropriate health state to undergo surgery.
  5. Arrival at the Hospital: On the day of surgery, patients are typically asked to arrive several hours before their procedure is scheduled to begin. This time is used for the final preparations and to address any unexpected issues that might arise.

Please note that this is a general overview of the process, and detailed procedures may vary from one healthcare provider to another.

How Long Between Pre-Op and Surgery?

This will vary depending on the hospital, procedure, surgeon, and ancillary team. For procedures being done inside a large hospital system, and the patient is undergoing sedation and intubation, the patient is typically required to arrive at the hospital about 2 hours prior to the scheduled start time.

Suppose the procedure is being done in an outpatient setting and will not require substantial sedation and/or intubation. In that case, the patient may be asked to arrive only 1 hour to 30 minutes prior to surgery.

Who is in the Operating Room During Surgery?

The operating room is busy, with many people working together to ensure you have the best experience possible. The patient's surgeon and anesthesiologist are the leading players in any surgery, but many others may be present depending on the procedure.

  • Surgeon: This is the doctor who performs all of the surgeries and other procedures. They make decisions about what needs to happen during the operation so that it goes smoothly and safely for everyone involved.
  • Anesthesiologist: This person ensures that everything happens as planned while the patient is under general anesthesia (when unconscious). They give directions to nurses or other support staff based on what they see happening in real-time during surgery.
  • Nurse/Scrub Tech: Nurses help prepare patients before entering ORs by assessing their health status; preparing equipment needed during procedures; administering medications according to physician orders; monitoring vital signs throughout each stage of surgery (before induction through recovery); assisting surgeons during procedures; documenting patient outcomes after surgery has ended, the list goes on! Scrub techs assist nurses by preparing instruments used during surgeries, such as bringing the appropriate tools into the OR and cleaning up after surgeries.

What Happens in the Operating Room Before Surgery?

Before surgery, several key steps take place in the operating room to ensure that the patient is adequately prepared for the procedure. These may include:

  1. Pre-operative assessment: The surgical team will thoroughly assess the patient's medical history, current health status, and any medications or allergies they may have. This information will help to guide decisions about anesthesia, pain management, and other aspects of the surgical process.
  2. Anesthesia administration: The anesthesia team will administer the appropriate type and amount of anesthesia to ensure the patient remains comfortable and pain-free throughout the procedure.
  3. Patient positioning: The surgical team will carefully position the patient on the operating table to ensure they have access to the area of the body that will be operated on.
  4. Surgical site preparation: The surgical team will clean and sterilize the body area that will be operated on to minimize the risk of infection.
  5. Equipment setup: The surgical team will set up all equipment and supplies for the procedure, including instruments, surgical drapes, and monitoring devices.

By taking these steps before surgery, the surgical team can help to ensure that the procedure goes smoothly and that the patient receives the best possible care.

What Is a Pre-op?

The patient waits in the pre-op room before moving into the operating room. It's usually in the same building as the surgery and has comfortable chairs and sometimes televisions.

The surgery center provides a gown, socks, slippers, and other items a patient must wear before the procedure.

Why Arrive 2 Hours Before Surgery?

To help prepare for surgery, here is a list of things that happen during the 2 hours before going into the operating room:

  • The anesthesiologist meets with the patient to discuss any medical conditions affecting anesthesia.
  • A nurse gives the patient instructions on how to care for themself after surgery, including when to take medication and what side effects should be reported.

If it's impossible to arrive two hours before the scheduled time, it's essential to call at least 30 minutes before arrival so the team can make arrangements for someone in their party who will be there on time and aware of these instructions (if needed). If this cannot be done, most teams ask that the patient arrive as soon as possible following these directions to avoid delays in getting started with the procedure or treatment plan.

Do They Remove Your Gown During Surgery?

Yes, your gown will be removed during surgery. It’s common practice to remove the dress during surgery because it can become contaminated with bodily fluids or other substances that could contaminate the surgical site.

Your surgeon will ask you to undress so that they can make sure that nothing is underneath the clothing that could cause harm to you or others in the operating room. Your gown will be replaced after surgery so you can dress when ready to leave the OR.

How Long Does Surgery Usually Take?

In general:

  • If multiple procedures are done simultaneously (e.g., hysterectomy plus bilateral oophorectomy), the total time under anesthesia will be longer.
  • The more complex your procedure(s), especially if it involves more than one organ system being accessed through one incision point (e.g., laparoscopic hysterectomy) or if it's exploratory, will also affect how long your stay in recovery takes after waking up from anesthesia.

The 10 Most Common Surgical Procedures

Let's consider the following (approximately) 10 most common surgical procedures, with their general durations and estimated recovery times. These durations are typical, but the actual times can depend on various factors, such as the patient's underlying health conditions and the specific nuances of the case.

Surgical Procedure

Procedure Duration

Recovery Room Duration

Post-Op Recovery Time

Cataract Surgery

15-45 minutes

About 30 minutes

1-2 weeks

Appendectomy (uncomplicated, appendix removal)

1-2 hours

1-2 hours

2-4 weeks

Cesarean Section (C-Section)

Around 1 hour

2-4 hours

6-8 weeks

Total Hip Replacement

2 hours

1-2 hours

3-6 months

Coronary Artery Bypass Grafting (CABG)

3-6 hours

24 hours

6-12 weeks

Cholecystectomy (Gallbladder Removal)

1-2 hours

1-2 hour

2-4 weeks


2 hours

2-4 hours

1-2 weeks

Total Knee Replacement

1-3 hours

1-2 hours

3-6 months


2-3 hours

2-3 hours

4-6 weeks

Transurethral Resection of the Prostate (TURP)

60-90 minutes

1-2 hours

2-4 weeks


Please note that while this table includes many of the most common surgeries, many variables, including the patient's age, overall health, presence of comorbidities, and the specific surgical approach used, can affect these numbers significantly.

What Happens After Surgery?

After surgery, the patient is taken to the recovery room. They may feel dizzy and disoriented when they wake up, but that is expected. The surgeon or anesthesiologist will monitor the patient for a few hours before discharging them from the hospital.

After surgery: keep the incision(s) clean and dry, apply ointment as directed by the doctor, do not use lotion on them until instructed otherwise, and avoid getting water near the incision sites.

If this happens accidentally, wash your hands with soap and water and then dry the incision site thoroughly with clean gauze pads. You should also avoid heavy work/exercise activities until all stitches have been removed during follow-up visits (usually within 1-2 weeks).

Get Trained in Operating Room Protocols

Surgery is a big step, and knowing what happens during the procedure is essential. We've outlined all the stages from prep to recovery, so you're well-informed about everything in an operating room.

Will you be working in and around an OR? Protect yourself, the patient, and your team by undergoing online training! Our Operating Room Protocols course will teach you how to navigate sterile fields, pre and post-op checks, and what to expect (plus, it's a requirement by most employers).

It’s highly recommended to undergo training to learn the guidelines for sterile technique, creating and maintaining a sterile field, and safety before entering the OR. Plus, for most hospitals, it's a requirement. Get started today!