LESSON 5

POST-OPERATIVE COMPLICATION 

• Is a term used by a medical professionals to refer something which was not intended to happen. Postoperative complications are problems that can happen after surgery but which were not intended.

• Complications are common and occur frequently despite precautions. Some postoperative complications are related to the exact surgery done but many (such as wound infection) may occur after any kind of surgery.

Types of Post-op Complications 

ATELECTASIS 

• Atelectasis is a complete or partial collapse of the entire lung or area of the lung resulting in abnormal alterations in lung function or compromise to the lung’s immune defenses.

• General anesthesia is a common cause of atelectasis. It changes the regular pattern of breathing and affects the exchange of lung gasses, which can cause the air sacs to deflate.
  
  

Clinical Features and Management

• Patients with atelectasis will present with varying degrees of respiratory compromise. The most common clinical features are increased respiratory rate, reduced oxygen saturations, fine crackles over the affected pulmonary tissue, and low grade fever (in some cases)

• Prevention or treatment of atelectasis includes voluntary deep breathing, incentive spirometry, intermittent positive pressure breathing (IPPB), chest physical therapy, bronchoscopy, aerosol therapy, and more recently, intermittent continuous positive airway pressure (CPAP) by mask.
  
  

PNEUMONIA

• Pneumonia is defined as a lower respiratory tract infection with accompanying consolidation visible on chest x-ray. There are four main types of pneumonia: 

• Community Acquired Pneumonia (CAP)

• Hospital-acquired Pneumonia (HAP)

• Aspiration Pneumonia 

• Immunocompromised Pneumonia 

Clinical Features

• Patients with hospital-acquired pneumonia classically present with a combination of cough (productive or non-productive), dyspnoea, or chest pain.

• However, many post-operative patients may not present as ‘clear-cut’ as this, due to factors such as intubation, reduced consciousness, or other comorbidities. Indeed, the only clinical features may be a general malaise, pyrexia, or impaired cognition.

PULMONARY EMBOLISM 

• Refers to the obstruction of the pulmonary artery or one of its branches by a thrombus (or thrombi) that originates somewhere in the venous system or in the right side of the heart. Active leg exercises to avoid venous stasis, early ambulation, and the use of anti-embolism stockings are general preventive measures.

Clinical Features 

• Dyspnea, tachypnea (most common) Chest pain (usually sudden) Anxiety, fever, tachycardia, apprehension, cough, diaphoresis, hemoptysis, and syncope.

Prevention

• Active leg exercises to avoid venous stasis, early ambulation, and the use of anti-embolism stockings are general preventive measures.
  
  

ASPIRATION PNEUMONIA

• an infection of the lungs caused by inhaling saliva, food, liquid, vomit and even small foreign objects. It can be treated with appropriate medications. If left untreated, complications can be serious, even fatal.

Symptoms:

• Shortness of breath (dyspnea) or wheezing

• Coughing blood or pus

• Chest pain

• Bad breath

• Extreme tiredness

SHOCK

• Shock can best be defined as clinical syndrome that results from inadequate tissue perfusion, creating a n imbalance between the delivery of oxygen and nutrients needed to support cellular function.

THROMBOPHLEBITIS 

• an inflammatory process that causes a blood clot to form and block one or more veins, usually in the legs. The affected vein might be near the surface of the skin (superficial thrombophlebitis) or deep within a muscle (deep vein thrombosis, or DVT).
  
  

Prevention

• Take a walk

• Move your legs regularly

• Drink plenty

DEEP VEIN THROMBOSIS 

• Deep venous thrombosis (DVT) is clotting of blood in a deep vein of an extremity (usually calf or thigh) or the pelvis. It results from conditions that impair venous return, lead to endothelial injury or dysfunction, or cause hypercoagulability.
  
  

Clinical Features and Management

• pain in the affected limb that begins in the calf swelling in the affected limb a warm feeling in the swollen, painful region of the leg red or discolored skin.

• Regular movement: Maintaining pressure on the at-risk area: Anticoagulant medication Thrombolysis Inferior vena cava filter Compression stockings.

DELIRIUM

• A neuro cognitive syndrome caused by reversible neuronal disruption due to an underlying systemic perturbation. It is a form of acute end-organ dysfunction which can be used as a marker of brain dysfunction.

Post-operative factors:

• Low hemoglobin

• Hypoxemia 

• Pain

• Hypoalbuminemia 

• Liver failure 

• Renal failure 

• sleep -wake disturbances 

PERIOPERATIVE STROKE 

• It is a brain infarction of ischemic or hemorrhagic etiology, which occurs during surgery or within 30 days after surgery, including the development of stroke after recovering from anesthesia.

• Common risk factors for perioperative stroke include advanced age, history of cerebrovascular disease, ischemic heart disease, congestive heart failure, atrial fibrillation, and renal disease.

Management 

• Perioperative use of beta blockers 

• Intravenous thrombolysis 

• Intra-arterial mechanicalthrombectomy 

• Intravenous infusion of unfractionated heparin 

DEPRESSION

• is a complication that can happen after any type of surgery. It’s a serious condition that needs attention so that you can find the treatments that can help you cope. 

• After an operation, factors that can increase the risk of depression include:

• reactions to anesthesia 

• the effect of antibiotics pain and discomfort while recovering 

• reactions to certain pain relievers 

• physical, mental, and emotional stress resulting from the illness, the surgery, or both 

• concerns about the impact on the quality of life or lifespan. 

INFECTION

• Surgical site infection (SSI) typically occurs within 30 days after surgery.

• Superficial Incisional SSI - occurs just in the area of the skin where incision was made.

• Deep Incisional SSI - occurs beneath the incision area, in muscle and the tissues surrounding the muscles .

• Organ or Space SSi - Can be in any area of the body other thaN the mentioned above. This includes body organs and spaces between them.

Clinical Features 

Any SSI may cause redness, delayed healing, fever, pain, tenderness, warmth, or swelling. Superficial incisional SSI - may produce pus from the wound site. Samples of the pus may be grown in a culture to find out the types of microorganisms causing the infection 

Deep Incisional SSI - may produce pus as well. The wound site may open on its own, or a surgeon may reopen the wound and find pus inside. 

Organ or Space SSI - may show a discharge of pus coming from a drain placed through the skin. An abscess (enclosed area of pus and disintegrating tissue surrounded by inflammation) may be seen when the wound is reopened or by special x-ray studies.

WOUND DEHISCENCE 

• Wound dehiscence is the separation of the edges of a surgical wound. It may be just the surface layer or the whole wound. It may become a serious problem. See your doctor if a wound has split open.
  
  

Prevention

• Follow you care team's instructions which may include: 

• Antibiotics before surgery Antibiotics after surgery 

• Keep light pressure on the wound when applying dressing 

• Keep wound area clean 

• Carefully follow any instructions from your care team 

EVISCERATION

• Evisceration is the uncontrolled exteriorization of intra abdominal contents through the dehisced surgical wound outside of the abdominal cavity. 

• Evisceration may occur from omentum but is of greatest concern when bowel protrudes through the separated fascia. 

DELAYED HEALING

• A non-healing surgical wound can occur after surgery when a wound caused by an incision doesn’t heal as expected. This is usually caused by infection – a rare but serious complication.

Causes 

• Bacteria on the skin or from other parts of the body 

• Weakened immune system 

• Medical conditions such as diabetes Lifestyle habits such as smoking or poor nutrition

• Advanced age 

HEMORRHAGE 

• Hemorrhaging is the bleeding that occurs inside the body when a blood vessel is damaged. minor hemorrhages are common and usually only produce tiny red specks on the skin or minor bruising, but large uncontrolled hemorrhages are life threatening and require immediate care and attention.

Symptoms of hemorrhaging include:

• Lightheadedness 

• confusion, memory loss, or disorientation 

• diarrhea 

• low blood pressure, rapid heart rate decreased urine output cold

• clammy skin

• organ failure 

HEMATOMA

• Postoperative hematoma, a collection of clotted or partially clotted blood within the operative bed, is among the most common postoperative complications in Otolaryngology.
  
  

WHO is at risk of developing hematoma?

• patients who have been taking blood thinners 

• those with some pre existing diseases or bleeding disorders 

• Other risk factors include vigorous exercise, straining, vomiting, stress, and alcohol consumption. 

PARALYTIC ILEUS

• refers to obstipation and intolerance of oral intake due to nonmechanical factors that disrupt the normal coordinated propulsive motor activity of the gastrointestinal tract following abdominal or non abdominal surgery.

URINARY RETENTION

• The inability to urinate after a surgical procedure despite having a full bladder. It is a relatively common complication of both outpatient and inpatient procedures and, having the ability to recognize and manage postoperative urinary retention is essential for any provider responsible for the treatment of a postoperative patient.

FUNCTIONAL DECLINE

• is the decrement in physical and/or cognitive functioning and occurs when a person is unable to engage in activities of daily living, as is encountered during hospitalisation.