Surgery

Question 1

What are the options for thromboprophylaxis

Answer 1

Mechanical: TED stockings, intermittent pneumatic compression

Pharm:
- Fondaparinux (ATIII-i)
- LMWH
- DOACs
- Unfractionated heparin (if CKD)

Question 2

What thromboprophylaxis is given for elective hip replacement surgery

Answer 2

Start LMWH 6-12 hours after surgery

• LMWH 10d → aspirin 28d + stockings
• LMWH 28d + stockings
• Rivaroxaban + stockings

Question 3

What thromboprophylaxis is given for elective knee replacement surgery

Answer 3

Start LMWH 6-12 hours after surgery

• Aspirin 14d
• LMWH 14d + stockings
• Rivaroxaban

Question 4

What thromboprophylaxis is given for elective fragility fracture surgery

Answer 4

Start LMWH 6-12 hours after surgery

• LMWH
• Fondaparinux

Question 5

What is ERAS

Answer 5

Enhanced recovery after surgery, aims to reduce risk of adverse outcomes

Pre-operative → aggressive physiological optimisation:
- Smoking cessation for ≥4 weeks
- Avoid prolonged fasting
- CHO loading

Intra-operative:
- Short-acting anaesthetics (incl. epidural if possible)
- Minimally invasive
- Avoid drains/NG tubes

Post-operative:
- Aggressive pain/nausea management
- Early mobilisation/physiotherapy
- Early resumption of PO intake
- Remove drains/catheters ASAP

Question 6

What are the causes of post-op pyrexia

Answer 6

Wind (day 1): physiological response, atelectasis, pneumonia
Water (day 3): UTI
Wound (day 5): SSI, anastomotic leak
Walking (day 7): DVT/PE

Question 7

What are the signs of post-op atelectasis and how should you manage it

Answer 7

Pyrexia
Reduced sats
Reduced breath sounds at bases

Reposition upright + chest physio

Question 8

What are the types of post-op haemorrhage

Answer 8

Primary continual bleeding that started during surgery

Reactive bleeding ≤48 hours of surgery

Secondary bleeding ≥48 hours of surgery (7-10 days, usually due to infection)