Disease - Post-operative complications

From CambridgeNotes

Immediate: first day

  • General: anaesthesia reaction, asphyxia, broken tooth
  • Specific: primary haemorrhage, reactive haemorrhage, structure damage

Early: first week

  • General: chest infection, urinary tract infection (UTI), pulmonary embolism (PE), bed sores
  • Specific: secondary haemorrhage, wound infection
  • Common post-op presentations
    • Fever: causes include 5W’s (wind, water, wound, walking, wonder drugs) or 7C’s (chest, catheter, cannula, CVP, cut, collection, calves); history, examination, urinalysis, FBC, CRP, cultures
    • Poor urine output: causes may be prerenal (hypovolaemia), renal (acute tubular necrosis), or postrenal (blocked catheter may lead to anuria); history, examination, urinalysis, U&E; catheterise (postrenal), check fluid balance and U&E, then give fluid challenge (prerenal), urine : plasma osmolality <1 (renal)
    • Wound infection: usually S. areus or E-coli; dressing and antibiotics; if abscess present drain
    • Other presentations (see under relevant emergency): if hypotension or shock always exclude haemorrhage; if chest pain always exclude acute coronary syndrome (ACS); if shortness of breath present always exclude pneumothorax, PE, or pneumonia; if confusion present exclude pathology, give haloperidol?

Late: first month – few general complications

  • Specific
    • Small bowel surgery may lead to short gut syndrome
    • Colon surgery may lead to ileus, fistulae, or anastomotic leak
    • Thyroid surgery may lead to recurrent laryngeal nerve palsy, hypothyroidism, hypoparathyroidism, tracheal compression