Post-operative complications Flashcards
What are some common early post-op complications?
Haemorrhage - surgical site bleeding or intra-abdominal bleeding
Hypostatic pneumonia
Surgical site superficial infection
DVT = potentially leading to PE
AKI
Delerium (hyper or hypoactive)
Wound dehisicene
Post-operative ileus
How can pain management go wrong post surgery?
Inadequate pain relief
Opioid overdose
What are the key signs of an opioid overdose?
Respiratory rate
Decreased GCS
Pinpoint pupils
What are the signs of an acute kidney injury post surgery?
Raised urea/creatine and dark concentration urine
Often these patietns have/are NBM pre surgery might not have adequate fluid intake, hypotensive during surgery can lead to hypoperfusion of the kidneys.
What is wound dehiscene?
A partial or total serpration of previously approximately wound edges due to a failure of proper wound healing.
This scernio typically occurs 5 to 8 days following surgery when healing is still in the early stages.
How is post-operative ileus?
A deceleration in intestinal motility following surgery. It is classified as a functional bowel obstruction and is very common, particularly after abdominal surgery or pelvic orthopaedic surgery.
Signs - failure to pass flatus or faeces, bloating and distention, nausea and vomiting or high NG output
What are some delayed post op complications?
Adhesion - chronic abdo pain and inc risk of bowel obstructions
Incisional hernias - most common on midline
Both of which increase risk of mechanical bowel obstruction.
What is the risk management for a post-operative haemorrhage?
Stop anticoagulants before surgery
Patients on warfarin need an INR check <1.5
Anticoagulants are not restarted until 48hrs post op or later is actively bleeding
What is the risk management strategy for post-operative infection?
Aspect technique during surgery
Prophylactic antibiotics before/after surgery
Some prosthetic joint replacements often have antibiotic coatings
Close monitor after surgery e.g daily wound checks or routine post-op bloods.
What is the risk management for a post operative VTE?
Non-pharmaceutical = compression stocking, early remobilisation
Pharmaceutical - LMWH or resume anti-coagulant at earliest opportunity, prophylaxis given for an extended period
What is the risk management strategy for post-operative pain?
Balance - adverse v therapeutic effects, can be hard in delirious/cog impaired patients who can not quantify pain
Use protocols to ensure adequate pain relief
Refer to pain management tram
Be cautions of patients on morphine with an AKI as increased risk of opioid toxicity
What is the risk management plan for post operative delirum?
Incorporate PINCH ME into assessment of frail patients
Includes daily reviews of bowel and fluid charts etc
Increasing frail patients post-surgery are receiving geriatrician reviews.
What is the use of the PINCH ME pneumonic for patients with delirum?
Identifies some possible causes of the patients delirum
Pain
Infection
Nutrition
Constipation
Hydration
Medications - opiods
Environment - aka hospital ward
What factors increase the risk of surgical complications?
Smoking - 2x all comp
Diabetes - 2x poor wound healing/infection, 1.5x death
COPD - 2x death, 90x pulmonary complications
CKD - 2x infection, CVS and pulmonary complications
Frailty - 4x death, 2x complications and discharge not home
Also:
Cognitive dysfunction
Obesity
Age (lower physiological reserve)
Anaemia
What specific circumstances for any patient might increase the risk of complications from a surgery?
Recent cold - within 2 weeks
Recent heart attack (ever to recent)
Recent stroke (within 9 months)
Allergies
