Postoperative Complications Flashcards
Immediate Postoperative Fever
Within 24 hours
Early Postoperative Fever
Within first 3 hours after surgery
Late postoperative fever
After postoperative day 3
Causes of Immediate Postoperative Fever
Inflammation
Trauma-related
infections predating the operation
Immune reactions to blood products
Malignant Hyperthermia
Malignant Hyperthermia
Rare reaction to anesthetics: Halothane, Succinylcholine
Fever, Muscle Rigidity, Muscle damage, Increased CK
Tachycardia, HTN, Hyperkalemia
Hypercarbia (elevated end-tidal CO2)
Resistant to increased minute ventilation
Cause of Malignant Hyperthermia
Ryanodine-R sarcoplasmic Reticulum
-dumps calcium
– Ca = consumption of ATP for SR Reuptake
—ATP Consumption = heat = tissue damage
Treatment for Malignant Hyperthermia
Dantrolene (Muscle relaxant)
Causes of Early Postoperative Fever (1-3 days)
Trauma or burn mediated
Infections
Idiopathic
UTI
Pneumonia
Early surgical site infection
Idiopathic Early postoperative fever
believed to be due to inflammation/cytokines
Early surgical site infection
Most after day 5
Group A Streptococcus
Clostridium Perfringens
Fever, Erythema, Wound Drainage
Postoperative MI
Most common within 72 hours of surgery
Treated as STEMI/NSTEMI
Causes of Late Postoperative Fever
Anastomotic leak
deep abdominal abscess
ischemia (vascular surgery)
Febrile drug reactions
Venous thromboembolism
Gout
Surgical Site Infections
Erythema, warmth, edema, pain at incision site
fever, leukocytosis
Treatment for Surgical Site infections
Antibiotics +/- Surgical Debridement
Non-pharmacologic prevention of Venous Thromboembolism
Early Ambulation
Pneumatic Compression
Pharmacologic Prevention of Venous Thromboembolism
LMWH
Low dose UFH
Fondaparinux ( Xa Inhibitor)
Post-op Fever: Wind
Atelectasis or Pneumonia
-24 to 48 hours post-op
Post-op Fever: Water
UTI
-3 to 5 days post-op
Post-op Fever: Wound
Wound infection
-5 to 7 days post-op
Post-op Fever: Venous Thromboembolism
7 to 10 days post-op
Post-Op Fever Workup
H&P
CBC with Diff
CXR
UA and Culture
Sputum Culture and Gram stain
Blood Cultures
Treatment for Post-op Nausea and Vomiting
Serotonin (5-HT3) Receptor Antagonists
-Ondansetron
-may cause constipation/headache
-prolong QT
Fascial Dehiscence
Wall tension overcomes suture strength
-often in abdominal surgical incisions
Risk Factors for Fascial Dehiscence
Inadequate Closure
Infection
Malnutrition
Diabetes
