Complications of Surgery Flashcards by Mollie O

What can surgical complications be divided into?

Immediate (<24hours)
Early (1 day - 1 month)
Late (>1 month)

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What are the immediate complications of surgery?

Oropharyngeal trauma from intubation
Surgical trauma to local structures
Primary or reactive haemorrhage

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What are the early complications of surgery?

Secondary haemorrhage
VTE
Urinary retention
Atelectasis and pneumonia
Wound infection and dehiscence
Antibiotic associated colitis

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What are the late complications of surgery?

Scarring
Neuropathy
Failure or recurrence

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What are the classifications of haemorrhages?

Primary
Reactive
Secondary

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What is a primary haemorrhage?

Continuous bleeding starting during surgery

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What is reactive haemorrhage?

Bleeding at the end of surgery, or early post-op

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What is reactive haemorrhage secondary to?

Increased CO and BP

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What is secondary haemorrhage?

Bleeding >24 hours post-op

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What is secondary haemorrhage usually due to?

Infection

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What are the causes of post-op urinary retention?

Drugs
Pain
Psychogenic

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What drugs can cause post-op urinary retention?

Opioids
Epidural/spinal
Anti-AChM

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How does pain lead to urinary retention?

Sympathetic activation leads to sphincter contraction

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What are the risk factors for post-op urinary retention?

Male 
Older age
Neuropathy
BPH
Surgery type

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Give two examples of causes of neuropathy that might cause post-op urinary retention

Diabetes

Alcoholic

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Give two examples of surgery types with increased risk of post-op urinary retention

Hernia

Anorectal

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What is involved in the conservative management of post-op urinary retention?

Privacy
Ambulation
Void to running taps or in hot bath
Analgesia

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What is done if conservative management for post-op urinary retention fails?

Catheterise, with or without gent 2.5mg/kg IV stat

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What might be done if a patient fails TWOC?

May be sent home with silicone catheter and urology follow up as outpatient

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How common is pulmonary atelectasis post-operatively?

Occurs after nearly every GA

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Why does pulmonary atelectasis occur post-operatively?

Anaesthetics increase mucus production and reduce mucociliary clearance, and pain inhibits respiratory excurison and cough, causing mucus plugging and absorption of distal air, leading to collapse

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What increases the risk of post-up pulmonary atelectasis?

Pre-op smoking

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When does post-op pulmonary atelectasis occur?

Within first 48 hours

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What are the signs and symptoms of post-operative pulmonary atelectasis?

Mild pyrexia
Dyspnoea
Dull bases with reduced air entry

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How is post-operatively pulmonary atelectasis managed?

Good analgesia to aid coughing | Chest physiotherapy

When do post-op wound infections occur?

5-7 days post op

What organisms cause post-op wound infection?

S. aureus | Coliforms

What are the operative classifications, regarding risk of wound infections?

Clean Clean/cont Contaminated Dirty

What is a clean operation?

Incision of uninfected skin without opening viscus

What is a clean/cont operation?

Intra-operative breach of viscus, but not colon

What is a contaminated operation?

Breach of viscus, and spillage or opening of colon

What is a dirty operation?

Operation on site already contaminated by faeces, pus, or trauma

What are the pre-operative risk factors for wound infection?

Older age Comorbidities, e.g. diabetes Pre-exisiting infection, e.g. appendix perforation Patient colonisation, e.g. nasal MRSA

What are the operative risk factors for wound infection?

Op classification and wound infection risk high | Longer duration

What are the post-operative risk factors for wound infection?

Contamination of wound from staff

How are wound infections managed?

Regular wound dressing Abx Abscess drainage

When does wound dehiscence present?

10 day post-op

What is wound dehiscence preceded by?

Serosanguinous discharge from the wound

What are the pre-operative risk factors for wound dehiscence?

``` Increasing age Smoking Obesity, malnutrition, or cachexia Co-morbidities Drugs ```

What co-morbidities increase the risk of wound dehiscence?

Uraemia Chronic cough Cancer Diabetes mellitus

What drugs increase the risk of wound dehiscence?

Steroids Chemotherapy (Radiotherapy)

What operative factors affect the risk of wound dehiscence?

Length and orientation of incision Closure technique Suture material

What post-operative factors affect the risk of wound dehiscence?

Increased intra-abdominal pressure Infection Haematoma/seroma formation

Give an example of a post-operative cause of increased intra-abdominal pressure?

Prolonged ileus leading to distention

How is wound dehiscence managed?

Replace abdominal contents and cover with sterile soaked gauze IV antibiotics Opioid analgesia Call senior and arrange theatre for repair

What IV antibiotics are given in wound dehiscence?

Cef + met

What is involved in surgical repair of wound dehiscence?

Wash bowel Debride wound edges Close with deep, non-absorbable sutures

What might a repaired wound dehiscence require post-operatively?

VAC dressing or grafting

What are the complications of cholecystectomy?

``` Conversion to open CBD injury Bile leak Retained stones Fat intolerance/loose stools ```

What is the rate of conversion to open in cholecystectomy?

What is the rate of CBD injury in cholecystectomy?

0.3%

What are the early complications of inguinal hernia repair?

Haematoma/seroma formation Intra-abdominal injury Infection Urinary retention

What is the rate of haematoma/seroma formation in inguinal hernia repair?

10%

What is the rate of infection in inguinal hernia repair?

What are the late complications of inguinal hernia repair?

Recurrence Ischaemic crisis Chronic groin pain/paresthesia

What is the rate of recurrence in inguinal hernia repair?

<2%

What is the rate of ischaemic orchitis in inguinal hernia repair?

0.5%

What is the rate of chronic groin pain/paresthesia in inguinal hernia repair?

What are the complications of appendectomy?

Abscess formation Fallopian tube trauma Right hemicolectomy

Why might a right hemicolectomy be required in appendicitis?

For carcinoid or caecal necrosis

What are the early complications of colonic surgery?

``` Ileus AAC Anastomotic leak Enterocutanoeus fistulae Abdominal or pelvic abscess ```

What are the late complications of colonic surgery?

Adhesions leading to obstruction | Incisional hernia

What are the causes of a post-op ileus?

Bowel handling Anaesthesia Electrolyte imbalance

How does a post-op ileus present?

Distention Constipation, with or without vomiting Absent bowel sounds

How is a post-op ileus managed?

IV fluids and NGT | TPN if prolonged

What are the complications of anorectal surgery?

Anal incontinence Stenosis Anal fissure

What are the complications of small bowel surgery?

Short bowel syndrome

At what length of bowel might a patient get short bowel syndrome?

<250cm

What are the complications of a splenectomy?

Gastric dilatation Thrombocytosis leading to VTE Infection with encapsulated organisms

How is gastric dilation following splenectomy prevented?

NGT

What are the complications of arterial surgery?

Thrombosis and embolisation Anastomotic leak Graft infection

What are the complications of aortic surgery?

``` Gut ischaemia Renal failure Aorto-enteric fistula Anterior spinal syndrome leading to paraplegia Emboli leading to distal ischaemia ```

What are the complications of breast surgery?

Arm lymphoedema Skin necrosis Seroma

What are the complications of urological surgery?

Sepsis | Uroma

How can urological surgery cause sepsis?

Instrumentation leading to infected urine

What is a uroma?

Extravasation of urine

What are the complications of prostatectomy?

Urinary incontinence Erectile dysfunction Rectograde ejaculation Prostatitis

What are the complications of thyroidectomy?

Wound haematoma leading to tracheal obstruction Recurrent laryngeal nerve trauma leading to hoarse voice Hypoparathyroidism leading to hypocalcaemia Thyroid storm Hypothyroidism

What % of patients who have a thyroidectomy have transient voice hoarseness?

1.5%

What % of patients who have a thyroidectomy have permanent voice hoarseness?

0.5%

Which of the recurrent laryngeal nerves is more commonly damaged in thyroidectomy, and why?

Right, because its more medial

What are the complications of a tracheostomy?

Stenosis Mediastinitis Surgical emphysema

What are the complications of fracture repair?

Mal or nonunion Osteomyelitis AVN Compartment syndrome

What are the complications of a hip replacement?

``` Deep infection VTE Dislocation Nerve injury Leg length discrepancy ```

What nerves might be damaged in hip replacement?

Sciatic | Superior gluteal nerve

What are the complications of cardiothoracic surgery?

Pneumothorax or haemothorax | Infection

What infections might you get in cardiothoracic surgery?

Mediastinitis | Empyema