POST-OPERATIVE COMPLICATIONS


DEFINITION
A simple list of problems occurring in the 10 days or so following an operation.

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EARLY (1-3 days post-op)

Heavy bleeding
Continuing loss of blood from sites of operation.
If internal:
--> poor recovery, pale, weak.
--> obs unstable
If neck surgery:
--> ?resp distress
Treatment
IV fluid / blood.
Evacuate blood if required.

Urinary retention
Inability to pass urine after an operation.
Esp males, older, young men.
Causes:
Abdo pain may prevent micturition.
Lying in bed.
Obstruction (e.g. prostatism).
Treatment
Catheterise
Target causes

Atelectasis
Collapse of small airways in part of the lung
A consequence of anaesthesia
(Not infective)
Causes:
Bronchial obstruction by mucus/ inadequate ventilation
 -> distal air absorption.
Pain inhibits free respiration.
Pathophysiology
Intrapulmonary shunting -> hypoxia.
Features
Tachypnoea, hyperpnoea, sats decreasing.
Fever, hypoxia, CXR collapse.
Treatment
Physio, coughing, O2, analgesia, hydration.

Arrhythmia
Supraventricular vs ventricular
Rate control vs rhythm control
Haemodynamic status
Consider MI, esp in bradycardia; block
Amiodarone = Class III with other class effects
B-blockade = Class II

Hypertension
Common cutoff value for severe hypertension is 180 systolic 120 diastolic
Common post-surgical problem; consider pain, meds, lack of routine antihypertensives, fluids, hypercarbia, hypoxia, hypothermia
Can increase bleeding / lead to graft failure
Beta-blockers common first-line; contraindicated if bradycardia, block, asthma, decompensated heart failure
Other options, including GTN patches can temporize

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LATER (3-10 days post-op)

Pneumonia
Lower respiratory tract infection, resulting from incomplete resolution of atelectasis or as a nosocomial problem.
15% get this.
Treatment:
Analgesia, antibiotics, O2, physio.

Wound infection
Usually endogenous bugs  (surgical ~sterile).
Fever.
Wound discharge.
Treatment
Remove sutures, drain pus, pack wound.

Wound dehiscence
Failure of the surgical wound to heal.
2% of procedures.
'Evisceration' if viscera protrude.
Serous leakage shows at 4-5 days.
Treatment
Resuture.

MI
0.5% risk if no previous history.
6% risk if MI in past 6mths.
30% risk if MI in past 3mths.
Usually at 3-5 days post-op as metabolic consequences of surgery are settling.
60% result in death.
50% are silent.

DVT/ PTE
10-15% of patients.
Causes:
Especially if cancer, obese, elderly.
Calf pumps not working.
Hypercoagulable state due to anaesthesia + operation.
Signs:

Calf pain, swelling, discoloured.
Pleuritic pain, haemoptysis, difficulty breathing, ECG, radioisotope scan, VQ scans.
Prevent.
First heparin, then oral anticoagulants.
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