He is credited with the invention of various kinds of surgical operations and developing his own technique of using plaster casts to treat fractured bones.

In search of an effective teaching method, he decided to apply anatomical research on frozen corpses.

He was also the first to use anesthesia in the field, particularly during the siege of Sevastopol (1854–55), and he introduced in Russian army a system of triage – sorting wounded soldiers into five categories.

[6] In 1856 after the end of war, he returned to Saint Petersburg and withdrew from the academy following the suggestion to work as a superintendent of schools of the Odessa Educational District which united several governorates.

[1] He wrote an influential paper on the problems of pedagogy, arguing for the education of the poor, non-Russians, and women.

[1] In 1861 he became a member of the Main Directorate of Schools, serving at the Ministry of National Education up until his death.

He lived in Heidelberg and at one point he treated Giuseppe Garibaldi's injury sustained at Aspromonte on 28 August.

In 1866 upon return to Russia he settled down at his estate, treating local peasants and establishing a free clinic.

[3] He last appeared in public on 24 May 1881 and died later that year at his Vishnya estate, Podolia Governorate (modern-day Vinnytsia, Ukraine).

Compared to the corpse of Lenin, which undergoes thorough maintenance in a special underground clinic twice a week, the body of Pirogov rests untouched and unchanging: it is said that only dust has to be brushed off of it.

The Pirogov Society was founded four years after his death, which aims for better medical training and treatment in Russia.

A bust portraying Russian admirals and sailors from the Crimean War, including Nikolay Pirogov, was erected at Sevastopol Park after renovations in 2008.