Surgical Principles: General Postoperative Complications

Postoperative Complications

• Highest Predictors of Postoperative Mortality: AKI (#1) & CHF
• Most Common Cause of Post-Op Infectious Death: Pneumonia
• Most Common Cause of Post-Op Respiratory Deficiency
  • Hypoxemia: Atelectasis
  • Hypercarbia: Poor Minute Ventilation
• Most Common Causes of Postop Readmission:
  • GI Problems (27%) – Nausea, Vomiting & Bowel Obstruction
  • Surgical Site Infection (22%)
  • Failure to Thrive/Malnutrition (10%)

Postoperative Fever

• Necrotizing Soft Tissue Infection: Immediate
• Postop Day: Mn
  • POD #1-3: Pneumonia (Not Atelectasis)
  • POD #2-3: UTI
  • POD #3-7: Surgical Site Infection
  • POD #5-7: DVT/PE
  • POD > #7: Drug or Other Causes

Surgical Site Infection (SSI)

• *See Wound Care: Surgical Site Infection (SSI)

Postoperative Urinary Retention (POUR)

• *See On Call: Oliguria & Urinary Retention

Postoperative Nausea and Vomiting (PONV)

• Most Common Anesthetic Complication Causing Readmission
• Increased Risk:
  • History of PONV
  • Female
  • Prolonged Opioid Use
  • Procedure Using Inhalational Anesthesia
• Decreased Risk:
  • Smoking
  • Procedure Using IV Anesthesia

Intraoperative Hypersensitivity Reaction

• Presentation: Difficulty Ventilating & Rash
• Most Common Causes:
  • Paralytics #1
  • Latex #2
  • Antibiotics #3

Malignant Hyperthermia

• Seen After Succinylcholine or Inhalational Anesthetics (Halothane & Enflurane)
• Cause: Uncontrolled Intracellular Ca Release from Sarcoplasmic Reticulum
  • Mutation: Autosomal Dominant; Ryanodine Receptor Gene (RYR1) Increases Risk
• Timing: 30 Minutes-24 Hours
• Most Common in Children & Young Adults
• Presentation:
  • Increased End-Tidal CO2 (First Sign)
  • Fever
  • Tachycardia
  • Muscle Rigidity
    • Trismus (Masseter Rigidity) > 20-30 Seconds
  • Acidosis
  • Rhabdomyolysis
• Diagnosis: Clinical Diagnosis
  • Definitive Diagnosis at a Later Date: Caffeine-Halothane-Contracture Test (Muscle Biopsy)
    • Has Many Issues (High False Positive Rate) & Rarely Performed
• Treatment: Stop Volatile Anesthetics & Give Dantrolene
  • Stop Surgery Immediately & Safely
  • Dantrolene
    • Inhibits Ca Release
    • Dose: 2.5 mg/kg, Repeat Every 5 Minutes Until Reversal

Perioperative Peripheral Nerve Injury

• Risk Factors:
  • Diabetic Neuropathy
  • Low Body Weight
  • Malnutrition
• Protective Factor: Obesity
• Most Have Documentation of Proper Positioning/Padding (Questionable Effects)
• Overall Incidence: 0.04%
• Presentation:
  • Paresthesias
  • Muscle Weakness
  • Extremity Pain
• Most Heal Spontaneously

Retained Foreign Object (RFO)

• Other Names:
  • Gossypiboma
  • Textiloma
• Most Common Object: Laparotomy Sponge
• Considered a “Never Event”