Uruk University/College of Dentistry

Fourth Year/General Surgery Assist. Prof. Khaleel A. Hassoon

Lecture 14

Postoperative Complications and Care

General Principles

1. After the operation, all anaesthetized patients should be safely transferred to the bed from the operating
table, under the supervision of the anesthetist and the surgeon, and should be recovered in the recovery
room.
2. The vital parameters (pulse rate, blood pressure, respiratory rate and temperature) should be monitored
and documented with the date of examination.
3. Clear operative notes should be written immediately which should include instructions on the postoperative
care.
4. Postoperative instructions relevant to the surgery:
 Observations required and frequency e.g. 4-hourly pulse & blood pressure measurement for 24
hours.
 Possible complications and action to be taken if complications occurred e.g. if blood loss
exceeds 500 ml in a drain-----call the surgeon.
 Treatment needed: e.g. intravenous fluid, antibiotics, analgesia.
 Time lines for patient recovery e.g. when to resume normal oral intake, when to mobilize,
dressing changes.

Postoperative Complications:
The postoperative complications may be minor and easily treated, so that recovery is not delayed, or they may be
major, hospitalization prolonged and death may occur.
Problems common to all major operations: Include:
1. Hypovolemic shock: inadequate tissue perfusion due to loss of blood from the intravascular lumen (e.g.,
bleeding) or fluid due to diarrhea or vomiting or burn.
2. Respiratory insufficiency: as in atelectasis: a complete or partial collapse of a lung or lobe of a lung —
develops when the tiny air sacs (alveoli) within the lung become deflated. It's a breathing (respiratory)
complication after surgery.
3. Cardiac failure
4. Electrolyte imbalance: as hyponatremia, hypokalemia
5. Oliguria: a condition in which urine output is less than 400 ml per 24 hours in adult, which may lead to
renal failure.
6. Postoperative jaundice: (jaundice: is yellowish discoloration of the sclera, mucous membrane and skin
due to increase the level of bilirubin in blood & liver failure.
7. Wound Infection & defective wound healing (dehiscence).
8. Alimentary tract dysfunction: as ileus: which is a paralysis of the wall of the intestine.
9. Vascular complication: as in deep vein thrombosis, or pulmonary embolism
10. Disorders of consciousness

Respiratory Complications:

Causes of respiratory insufficiency

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  Obesity
 Smoking
 Preexisting lung disease with smoking
 Retained pulmonary secretion with atelectasis.

It may occur either immediately or a few days later. The risk factors for its development are:
 Obesity
 Smoking
 Chronic lung diseases.

Treatment
 Treat the cause
 Cessation of smoking
 Early postoperative chest physiotherapy by repeated cough & bronchodilator.

Postoperative hypoxia
1- Upper airway obstruction due to the residual effect of general anesthesia, bronchial secretion.
2- Laryngeal edema from traumatic tracheal intubation.
3- Hypoventilation
4- Atelectasis and pneumonia especially after upper abdominal surgery

Renal and urinary complications:

1. The hourly urine output is the main point in assessment of the general state of the blood volume and the
renal function in the postoperative patient.
2. Postoperative renal failure is associated with high mortality.
3. Prophylactic measures to prevent renal failure should be taken in high risk patients.
4. Retention of urine and infection are common problems.

Gastrointestinal complications

1- Paralytic ileus: (atony): In paralytic ileus, muscle or nerve problems disrupt the normal coordinated
muscle contractions of the intestines, slowing or stopping the movement of food and fluid through
the digestive system. Paralytic ileus can affect any part of the intestine.
2- Bleeding
3- Infection
4- Anastomotic leakage

Cardiovascular complications

1. Hypotension: there are many causes for its development (e.g., Bleeding, Drugs)
2. Arrhythmia and myocardial infarction will need treatment with the help of cardiologist.
3. Tachycardia (sinus or supraventricular) may be caused by pain or anxiety.

Compartment Syndrome: This is a condition in which the patient experienced a severe pain which is greater than
expected, and unresponsive to analgesia. Usually occur in the upper and lower limbs, after trauma or surgery.

Deep Vein Thrombosis (DVT): DVT is a blood clot that develops within a deep vein in the body, usually in the leg.
Blood clots that develop in a vein are also known as venous thrombosis. DVT usually occurs in a deep leg vein, a

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larger vein that runs through the muscles of the calf and the thigh. A thrombus can break loose and cause a serious
problem in the lung, called a pulmonary embolism. (Obese, female, multipara, on contraceptive drugs)

Risk Factors of Deep Vein Thrombosis

Low risk Medium risk High risk

Maxillofacial surgery Inguinal hernia repair Pelvic surgery

Neurosurgery surgery Upper abdominal surgery Total hip & knee replacement

Cardiothoracic surgery Gynecological &urological

operations

Postoperative Confusion: causes:

1- Renal failure/ uremia

2- Hyponatremia & electrolyte disturbances
3- Urinary tract infection
4- Urinary retention
5- Respiratory hypoxia e.g. chest infection and atelectasis
6- Pulmonary embolism
7- Septic shock
8- Myocardial infarction
9- Dehydration
10- Drugs e.g. opiates, hypnotics, alcohol withdrawal
11- Neurological causes e.g. epilepsy, encephalopathy, head injury

Wound Dehiscence:

A surgical complication in which a wound rupture along a surgical incision.

Risk factors that predispose to wound dehiscence are classified into general and local:

1. General factors:
 Malnourishment
 Diabetes
 Obesity
 Renal failure
 Jaundice
 Cancer
 Steroid

2. Local factors:
 Inadequate or poor closure of wound
 Seroma, hematoma and infection
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 Increased intraabdominal pressure e.g. Repeated cough, ascites, abdominal gases.