A27. Postoperative complications, and their treatment, prevention

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Postoperative complications may be general or specific to the type of surgery. Most occur during day 1 – 3 after operation, but complications can occur before and after this time as well. Some complications occur much later, like incisional hernia.

General postoperative complications:

Postoperative fever

Postoperative fever is mostly due to infections like surgical site infection, pneumonia, catheter related UTI, and bacteraemia, although it can also be caused by non-infections like transfusion reactions, drug reactions, VTE, etc.

Unless a non-infectious etiology is suspected, cultures should be taken from blood, urine, and wound. Imaging may be useful to rule out pneumonia. The surgical wound should be inspected for signs of infection.

Antibiotic prophylaxis is important in the prevention of postoperative fever.

Postoperative nausea and vomiting

Postoperative nausea and vomiting (PONV) is a common postoperative complication. It’s often transient but may cause problems with oral feeding or metabolic complications, as well as discomfort for the patient.

The risk is higher in case of previous PONV, use of inhaled general anaesthetic, perioperative opioid use, and certain procedures like laparoscopy and gynaecological procedures.

Prevention involves using regional or intravenous anaesthesia where possible and minimising use of opiates. Those at high risk may receive antiemetics prophylactically. Treatment involves addressing contributing factors, ruling out ileus as a cause, and giving antiemetics.

Postoperative ileus

Surgery is the most common cause of paralytic ileus. It is thought to be due to a physiological response to surgery and usually resolves within 72 hours and is therefore considered physiological. Postoperative ileus which lasts longer than 72 hours is likely pathological.

Risk factors for postoperative ileus include open abdominal or pelvic surgery, long surgeries, manipulation of the GI tract during surgery, excessive use of IV fluids perioperatively, immobilisation, and the presence of other contributing factors like hypokalaemia and opioid use.

Prevention involves using minimally invasive surgery where possible, avoiding excessive use of opiates and IV fluids, early mobilisation, and early initiation of oral feeding.

Postoperative atelectasis

Postoperative atelectasis can be asymptomatic, or it may cause symptoms like dyspnoea and hypoxaemia. It’s associated with postoperative pain which interferes with deep breathing and coughing, which decreases clearance from the bronchial system. Atelectasis may predispose to pneumonia and lung abscess.

Sufficient analgesia, respiratory physiotherapy, and early mobilisation tare important to prevent postoperative atelectasis. Respiratory physiotherapy includes breathing and coughing exercises and use of a handheld PEP (positive expiratory pressure) device (“flute”) which keeps airways open and assists in clearance of mucus.