Definition & Overview
A post-operation review is a routine examination or evaluation procedure performed after certain surgical procedures are carried out mainly to ensure a smooth recovery. It involves assessing the patient's condition and ensuring that the goals of the procedures were achieved. It is performed as early as the day after surgery when signs of complications can already be detected.
Who Should Undergo and Expected Results
Post-operation review is carried out on those who have undergone certain inpatient surgical procedures with the goal to prevent potential complications or to identify them early on so they can be managed promptly.
During the review, the practitioner looks for several key signs or symptoms of any post-operative issues including wound-related complications. These include:
- Acute confusion
- Disordered wound healing
- Low urine output or urinary retention
- Abnormal discharge
A post-operation review also makes sure that the patient’s wound is properly cleansed and dressed, and that the patient receives adequate fluids to replace what the body lost from the operation. Inadequate fluid replacement usually causes low urine output in post-operative patients, and this symptom is usually detected during a post-operation review.
The goal of the review is to detect any potential problems early on and administer the necessary treatment to prevent further complications from developing. It aims to ensure the patient’s full recovery after the surgery. The post-operation review ends when the patient is discharged from the hospital.
How is the Procedure Performed?
During a post-operation review, a medical practitioner or nurse first reviews the patient’s medical information and other pertinent details such as number of days post-op, and the reason for the operation. The operation notes will also be checked to determine the patient’s recovery and management plan, and determine the stage where the patient is in the plan, and determine why the patient is still in the hospital, in the case of extended hospital stays.
This is followed by the review of check lab results, such as inflammatory markers, haemoglobin levels, electrolyte levels, and other results relevant to the surgery performed.
The patient will then be assessed, a procedure that occurs in different stages, namely:
- Questioning – The patient will be asked questions including:
- Are you experiencing any symptoms or other issues?
- Are you eating and drinking well? How much?
- How is your bowel movement? If there has been none since the operation, are you passing gas?
- How often do you need to go to the bathroom to urinate?
- How are your pain levels?
- Are you able to sit up, stand up, or move around?
- Nursing Chart – The medical practitioner will then put some notes on the nursing chart regarding his or her observations on the patient's:
- Fluid balance and oral intake limitations
- Urine output
- NG/NJ output, if applicable
- Drains output
- Tubes in situ – This is required if the patient has had drains, tubes, or catheters placed during surgery
- Drains, such as the Wallis drain, the Redivac negative pressure drain, or the Pigtail drain, among others
- Wound catheters
- Urinary catheters
- Central line
- Physical or visual examination – The nurse will also check on the patient’s:
- Drain output quality, such as if the drain is serous or bloody
- Drain output quantity
Other relevant tests
Medication review – The nurse will then check the patient’s medication schedule and whether the patient requires a new dose. If so, the patient will be given the said dose.
In patients who underwent serious procedures, the post-operation review may be extended and more complex. The patient may gradually transition from various stages of oral and food intake, analgesic use, and IV fluid intake.
In terms of oral intake, patients may be required to transition slowly through the following stages:
- NG/NJ with free drainage
- Spigotted NG/NJ
- Small sips
- Clear liquids at controlled quantities (i.e. specific mLs per hour)
- Clear free fluids, such as water or tea without milk
- Free fluids, or anything that is liquid, including soup
- Light/soft diet
- Normal diet
In the early stages, patients may require supplementations, usually in the form of multivitamins, which can be administered through NG feeding or TPN if the patient is unable to eat.
Analgesic use should also be gradually reduced in intensity. Patients are usually initially given PCA, then tramadol, then paracetamol with oramorph. The goal is to bring analgesic usage down to just paracetamol and, eventually, to cessation.
As for IV fluids, the goal is to reduce them as soon as oral intake is possible.
Possible Risks and Complications
A post-operation review is crucial in ensuring that patients do not suffer from the common surgical complications that may occur, such as:
- Surgical site infections or SSIs
- Wound dehiscence
- Blood loss
- Drug reactions
Other less common but more serious complications include:
- Tissue damage and necrosis
- Acute myocardial infarction
- Pulmonary embolism
- Chest infections
- Post-op atelectasis
- Urinary tract infection
- Bowel obstruction, usually related to fibrinous adhesions
- Paralytic ileus
- Atelectasis, or a collapsed lung that becomes secondarily infected
Some delayed effects of surgery also include:
- Incisional hernia
- Keloid formation
- Abscess formation or wound sinus
Pietrangelo A. “Postoperative care.” Medically reviewed by Krucik G. 2013 June. http://www.healthline.com/health/postoperative-care#Overview1
“Post-Op General Surgical Patient Review.” SCEStop. http://www.oscestop.com/Surgical%20patient%20review.pdf
Dinakaran S, Desai SP, Raj PS. “Is the first post-operative day review necessary following uncomplicated phacoemulsification surgery?” Eye (Lond). 2000 Jun; 14 (Pt 3A): 364-6. http://www.ncbi.nlm.nih.gov/pubmed/11027001