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SYSTEM-SPECIFIC COMPLICATIONS Respiratory system Early detection of respiratory complications is facilitated by periodic assessment of airway patency , respiratory rate and routine oxygen saturation measurement, performed during emergence and recovery as des...

Thoracic surgery Careful fluid management is important in patients undergoing a lobectomy or pneumonectomy as they are susceptible to fluid overload in the first 24–48 hours postoperatively . Chest drains require regular review . If the fluid in a chest drain swi...

Urology Catheter patency must be checked regularly following urolog ical surgery . In patients who have undergone transurethral resection of the prostate, continuous bladder irrigation may be used. More generalised complications can occur, for example transur...

Vascular surgery The patency of grafts and anastomoses, for example femoro popliteal bypasses and abdominal aneurysm, needs to be checked by regular clinical assessment of the limbs and by Doppler ultrasound in the postoperative phase. Vascular surgery The p...

Wound care Within hours of the wound being surgically closed, the dead space fills up with an inflammatory exudate. Within 48 hours of closure a layer of epidermal cells from the wound edge bridges the gap. Consequently , sterile dressings applied in theatre s...

Wound dehiscence Wound dehiscence is disruption of any or all of the layers in a wound. Dehiscence may occur in up to 3% of abdominal wounds, increases the risk of postoperative mortality and is very distressing to the patient. Wound dehiscence most common...

Abdominal surgery The abdomen should be examined daily for excessive disten - sion, tenderness or drainage from wounds or drain sites. In certain operations, such as those for intestinal obstruction or oesophageal and gastric procedures, a nasogastric tube ma ...

Cardiovascular system Thirty per cent of patients undergoing non-cardiac surgery will have at least one cardiovascular risk factor. In this group 30-day mortality is 0.5–2% as a result of cardiac complications. Routine pulse, blood pressure and electrocardio...

DISCHARGE OF PATIENTS Patients discharged home need a ‘discharge letter’ detailing the postoperative plan. The discharge letter should include details of the final diagnosis, the treatment and any complications that may have occurred. There should be advice fo...

Deep vein thrombosis Deep vein thrombosis (DVT) is a well-known and, when complicated by pulmonary embolus, potentially fatal compli - cation of surgery ( Table 24.6 ). All hospitals must have a process for screening all surgical patients to identify those at...

Drains Drains are used to prevent accumulation of blood and sero sanguineous or purulent fluid. In clean surgery , such as joint replacement, blood collected in drains can be transfused back into the patient provided that an adequate volume is collected rapidl...

ENHANCED RECOVERY Enhanced recovery is an approach to the perioperative care of patients undergoing surgery . It is designed to speed clinical recovery of the patient and reduce both the cost and the length of stay of the patient in the hospital. It is ach...

FURTHER READING Goren O, Matot I. Perioperative acute kidney injury . Br J Anaesth 2015; 115 (Suppl 2): ii3–14. https://anaesthetists.org/Home/Resources-publications/Guidelines/ Immediate-post-anaesthesia-recovery (accessed 27 November 2021). https://cpoc.org....

Fever About 40% of patients develop pyrexia after major surgery; however, in most cases no cause is found. The inflammatory response to surgical trauma may manifest itself as fever, and so pyrexia does not necessarily imply sepsis. However, in all patients wi...

Follow-up in clinic Patients should be reviewed in clinic if a key decision on management needs to be made. The �ndings and the care plan agreed with the patient at the clinic appointment should be included in a letter to the patient’s GP , as well as in ...

GENERAL POSTOPERATIVE COMPLICATIONS Bleeding Postoperative haemorrhage is most common in the immediate postoperative period. It may be caused by an arterial or venous leak, but also by a generalised ooze or a coagulopathy . Slow bleeds may go undetected for ho...

GENERAL POSTOPERATIVE PROBLEMS AND MANAGEMENT This section provides an overview of selected important post operative problems and the principles of their management. It does not set out to describe such problems relating to the vast arra y of all surgical t...

INTRODUCTION Perioperative care is integrated care delivered to the patient by a multidisciplinary team before, during and after surgery . The multidisciplinary perioperative team comprises doctors from various specialties, such as surgery , anaesthesia, acute...