Inclusion Criteria:  Aged 18 years and older Undergoing major thoracic and abdominal surgery Postoperative hospital stay expected to be at least one night Patients requiring less than 24 hour stay in PACU or ICU  Exclusion Criteria:  Patients aged less than 18 years Not receive major thoracic and abdominal surgery Stay in ICU is over 24 hours Hospital stay is less than 24 hours Patient not signing the informed consensus