TYPE OF POST OPERATIVE COMPLICATIONS
- General complications
- Specific complications
- Wound problems
GENERAL COMPLICATIONS
FEVER : It can be caused by following reasons:
A. PNEUMONIA:
- It can occur as a complication usually 48 hours onwards.
- Patient present with cough , fever, sob
- Investigation: CXR
- Rx: Antibiotics (amoxicillin)
B. URINARY TRACT INFECTION:
- Usually secondary to catheterization
- In elderly patient it can cause dysuria, frequency
- Investigation: MSU
- Rx: antibiotics (Trimethoprim)
C. ATELECTASIS:
- Lung collapse.
- Common in people who smoke.
- Presentation: Chest pain and mild fever.
- Usually occurs within first 48 hours after an operation which is close to the lung especially splenectomy.
- Investigations: CXR to R/O pneimonia.
- Rx: Physiotherapy.
D. WOUND INFECTION:
- Usually after 5 days post operative.
- Patient present with discharge from the wound, redness & tenderness around the wound.
- Investigations: wound swab, microscopy, culture and sensitivity.
- Rx: Antibiotics
E. INTRA-ABDOMINAL ABSCESS:
- Subphrenic abscess or sub hepatic abscess
- Usually after 5 days post operative.
- Patient presents with swinging fever.
- Investigations: CT abdomen
- Rx: Incision & drainage
F. ANASTOMOTIC LEAK:
- Usually after bowel resection
- Any physiological change after bowel resection is alwys anastomotic leak until proven otherwise.
- Never occur immediately after operation but after patient starts eating and drinking, usually 3-7 post operative day.
- Investigation: CT abdomen
- Rx: Antibiotics: IV immediately (cefuroxime+metronidazole)
- Laparotomy is the definitive treatment.
INTRA-ABDOMINAL BLEED:
- Usually few hours after surgery
- Management : Laparotomy
CONFUSION: It can be caused by:
A. INFECTION:
- UTI
- Pneumonia
- usually in elderly and after 5 post operative day
B. MEDICATIONS:
- Opiate usually used during an operation
HYPOXIA/ SOB /DYSPNOEA:
A. PULMONARY EMBOLISM : chest pain, hamoptysis, 5 days onwards after an operation
B. PULMONARY OEDEMA: Post operative pulmonary oedema is almost always due to fluid overload.
C. PNEUMONIA
D. PNEUMOTHORAX:
- Usually occurs due to ventilation pressure especially if there was a small pneumothorax.
- Chest drain must be inserted if it is small.
E. MYOCARDIAL INFARCTION:
- Patient presents with chest pain radiating to the left arm.
HYPOTENSION:
A. BLEEDING: IV Fluid
OTHER MEDICAL CONDITIONS : MI, PE or Sepsis
OLIGURIA:
- Post operative oliguria is almost secondary to inadequate fluid replacement.
- Rx: IV Fluid
ANURIA:
- Almost always due to blocked cathter
- Check catheter
POSTOPERATIVE HYPONATRAEMIA:
A. SIADH: especiall after brain surgery
B. Over hydration, especially with colloids because sodium gets diluted.
DEEP VENOUS THROMBOEMBOLISM:
- Pteinets usually present with unilateral calf swelling, pitting oedema, calf pain.
- In post-operative patients we do not use D-dimer as an investigation. But the investigation of choice is always a Compression Ultrasound Scan.
SPECIFIC POST-OPERATIVE COMPLICATIONS
1. MASTECTOMY:
- Common complication in lymphoedema (arm becomes swollen)
- Rx: Physiotherapy and arm exercise.
2. THYROIDECTOMY:
A. RECURRENT LARYNGEAL NERVE PALSY:
- Patient presents with hoarseness of voice.
- Usually resolves after 2-3 weeks if unilateral so just reassure.
- If bilateral , needs surgical airway.
B. TRACHEAL OBSTRUCTION BY HAEMATOMA:
- Usually presents with acute shortness of breath and stridor immediately after operation.
- Commonly seen when patient is still in recovery room
- Rx: release the stitches on the bedside
C. HYPOCALCAEMIA:
- Usually due to injury or aberrant removal of parathyroid glands during surgery.
- Patient presents with tetani, Chvostek sign and Troseau’s sign (carpopedal spasm), muscle irritability.
3. POST TURP SYNDROME:
- The irrigation fluid used to visualize and distend the urethra and bladder gains intravascular access through the venous circulation causing dilutional hyponatremia.
- Rx: Fluid restriction.
4. APPENDICECTOMY:
- Common complication is abdominal and pelvic abscess especially if it is perforated or gangrenous appendicitis.
- Usually patient will have swinging fever
- Investigations: CT scan abdomen or abdominal ultrasound
- Rx: I & D
5. SPLENECTOMY:
- Spleen takes part in immune system so splenectomy cause low immune funtion and patient will have recurrent infections.
- Prophylaxis vaccine is required against following infections:
– Pneumococcal
-Meningococcal
– Haemophilus influenza
- Patient also requires long term antibiotics prophylaxis.
6. ABDOMINAL SURGERY:
A. PARALYTIC ILEUS:
- Usually presents with abdominal distention, constipation, vomiting and reduced bowel sounds.
- Occurs few days after the operation
- No abdominal pain
- Investigation: Plain abdominal X-ray shows dilated bowel loops
- Management: Nasal gastric tube and intravenous fluid.
B. OBSTRUCTION SECONDARY TO ADHESIONS:
- This will occur after weeks, months or years
- Cardinal symptoms: Abdominal pain, vomiting , constipation, abdmoinal distension and increased bowel sounds
7. ERCP:
A. ACUTE PANCREATITIS
B. CHOLANGITIS
WOUND INFECTION
- Wound swelling , bleeding or discharge needs inspection/ exploration of the wound
1. LAPAROTOMY WOUND DEHISCENCE:
- Dehiscence of laparotomy wound is spontaneous opening of deep suture layers with or without superficial layer.
- Presents with serosanuinous discharge from wound and usually 7-10 days post operative.
- Rx: Resuture wound
2. WOUND BLEEDING:
- Usually bleeding is minor and settles spontaneously.
- Presents with oozing wound, haematoma on palpation.
- Rx: If minor bleeding, try gentle pressure for 5 minutes. If ongoing large amount of bleeding, patient may need to go to theatre
3. SUPERFICIAL WOUND INFECTION AND ABSCESS:
- Present with wound pain, pyrexia, pus like discharge
- Rx: Inspection/ exploration of wound
- If temperature >37.5, take blood cultures, CRP, FBC, U& E.
- If abscess: wound drainage, take swab for microscopy, culture & sensitivity.
