Definition & Overview
Whether minor or major, surgeries may come with post-operative complications due to various reasons, controlled and otherwise. While some are transient, others can be serious to the extent of being life-threatening. It is very important that risks involved in surgery are taken into consideration before, during, and after the procedure, and an efficient post-operation complication management should always be in place to ensure patient safety.
The likelihood of the occurrence of post-operative complications is dependent on several factors including the type and extent of surgery performed, the patient's pre-existing conditions and pre-surgical health status, and whether the procedure was done on an in-patient or outpatient basis, among many others. Some of the most common post-surgical and anaesthetic-related complications are as follows:
- Abscess formation
- Acute confusion or delirium
- Allergic reactions
- Basal atelectasis or lung collapse/malfunction
- Blood loss
- Bowel obstruction (often due to fibrous adhesions) or reduced bowel function
- Cardiovascular complications (such as dysrhythmias, infarction, and ischemic injury)
- Deep vein thrombosis (DVT) or pulmonary embolism
- Disordered wound healing (due to adverse complications)
- Hematoma or bruising
- Low urine output and inadequate replacement of body fluids
- Nausea and vomiting
- Post-operative fever
- Pressure sores
- Primary haemorrhage (which may occur during or after surgery due to increased blood pressure)
- Surgical injury due to unavoidable tissue damage, such as to nearby nerves
- Wound infections or wound dehiscence (rupture of surgical incision)
Among complications that occur weeks or even months after surgery include keloid formation, incisional hernia, persistent sinus, and possible recurrence of the cause of the surgery (such as in the case of malignancy or cancer metastasis).
Who Should Undergo and Expected Results
All patients who undergo surgery, whether a minor outpatient procedure or a major surgery performed in the operating room, are provided with postoperative care. In fact, this starts even before the procedure using appropriate preparation and effective counselling. Pre-operative management, which includes health assessment, identification of risk factors, and proper relay of information about the procedure and its short- and long-term recovery, typically overlaps with post-surgical care.
There are protocols currently in place for the prevention of post-operative complications. Some basic principles include weight and diet control, interventions for possible blood loss, proper technical preparation (i.e. choice of incision, technique, drainage, etc.), interventions for anastomotic leakage, and prophylactic use of antibiotics, among many others. This way, the patient and the medical staff can work hand-in-hand towards the success of the surgery and full patient recovery.
How is the Procedure Performed?
Post-operation complication management can be categorised into immediate and late post-operative management period.
In an immediate post-surgical management, the following procedures are usually done right after surgery:
Pain management - Adequate pain control is provided and may include the administration of oral or intravenous pain medications, sedatives, antibiotics, anticoagulants, and antiemetic.
Wound care - Incisions and dressing are constantly monitored for signs of infection.
Monitoring - Patients are regularly monitored for blood pressure and pulse. Fluid intake and release are also monitored, along with haematological values and serum electrolytes for proper fluid replacement. Respiratory status is also frequently assessed, as well as body temperature. The medical staff also watches out for bowel movement, leg oedema, abnormal redness, and pain (DVT).
Mobilisation - Early mobilisation is always encouraged post-operation. Patients are advised to perform permissible exercises and movement, deep breathing, muscular strengthening, and use of walking aids, when applicable.
Communication - Patients are regularly updated with their health condition and progress and constantly reassured of post-operative care.
Depending on the onset and the type of complication that occurs in the patient, certain interventions may be performed. For instance, pneumonia is treated using antibiotics and physiotherapy while cardiovascular problems are managed using medications or additional surgical procedures. Meanwhile, haemorrhage is managed through blood transfusion, wound infection through topical or oral antibiotics, and wound dehiscence through analgesics or re-suturing. Close monitoring is very important to ensure that all complications are detected early so they can be properly and promptly addressed.
When the patient is discharged from the hospital, post-operative care may continue depending on the procedure performed. Patients (or their family) are provided with a record of their diagnosis, summary of medical procedure, and instructions, such as about medications or additional therapy. If a follow-up appointment is required, instructions are also provided in the discharge documentation.
Possible Risks and Complications
All surgical procedures come with certain risks and complications, making post-operative complication management a must. This is a routine task performed by surgeons, doctors, and nurses to ensure patient safety, health, and overall wellbeing.
It is imperative for the procedure to be performed by highly experienced medical staff to ensure that post-surgical complications are not only minimised but also properly managed should they occur.
- International Society of Surgery