POSTOPERATIVE COMPLICATIONS 1

• Wound Complications
• Respiratory Complications
• Fat Embolism
• Cardiac Complications
• Postoperative parotitis
• Gastrointestinal Motility Complications
• Postoperative Pancreatitis
• Postoperative Hepatic Dysfunction
• Urinary Complications
• Cerebral Complications
• Psychiatric Complications
• Complications of IV therapy and monitoring
• Postoperative Fever
 POSTOPERATIVE COMPLICATIONS 2

• Postoperative complications may result from the

primary disease, the operation, or other unrelated
factors

WOUNDS COMPLICATIONS 1
• Hematoma:
– Collection of blood and clots in the wound.
– Aspirin, heparin, anticoagulants
– Neck hematomas (tyroid surgery)
• Seroma:
– Fluid collection in the wound other than pus or blood.
(Mastectomy)
 POSTOPERATIVE COMPLICATIONS 3

WOUND COMPLICATIONS 2
• Postoperative Wound Infection
– PNI results from bacterial contamination during or after
a surgical procedure.

Operative Wounds
1. Clean (1,5 %)
2. Lighty Contaminated (2-5 %)(Gastric, biliary)
3. Heavily contaminated (5-30 %) (colon, emergency)
4. Infected
• Usually appear between 5th-10th days after surgery with
fever and pain
• Open and drain
 POSTOPERATIVE COMPLICATIONS 4

Wound Complications(3)
Wound Dehiscence (1-3%)
• W.D is partial or total disruption of any or
all layers of the operative wound.
EVISCERATION: Rupture of all layers of
the abdominal wall and extrusion of
abdominal viscera
A) Systemic Risk Factors
Aging, d.m, üremia, immunosupression,
jaundice and cancer, obesity,
corticosteroids
 POSTOPERATIVE COMPLICATIONS 5

Wound Complications 4
Wound Dehiscence(2)
B) Local Risk factors
1. Adequacy of closure (too few stiches and too
close to the edge of the fascia)
2. Intraabdominal pressure
(COPD, obesity, cirhosis)
3. Deficient wound healing
(Infection, drains, hematomas)
 POSTOPERATIVE COMPLICATIONS 6

Wound Complications 5
• Wound Dehiscence(3)
– Observed between the 5th-8th postoperative
days
– The first sign of dehiscence is discharge of
serosanguinous fluid from the wound
– Evisceration should be operated on and wound
reclosed using full-thickness sutures
– If a partial disruption is stable, treatment may
be delayed and the resulting incisional hernia
accepted
– Stich abscesses
 POSTOPERATIVE COMPLICATIONS 7

Respiratory Compications 1
• Specific Diseases and Problems
– Acute upper respiratory tract infections
– Acute lower respiratory tract infections
(Tracheitis, Bronchitis, Pneumonia)
– Chronic obstructive pulmonary disease
(COPD; Bronchitis, Emphysema,
Bronchiectasis)
– Bronchial asthma
– Restrictive lung disease
(Pulmonary fibrosis, obesity)
 POSTOPERATIVE COMPLICATIONS 8

Respiratory Compications 2
• Atelectasis
– First 48 hours after operation
– Cause: obstruction due to secretions or
closure of bronchioles
– Oxygenation decreases and after 72 hours
infection and pneumonia develops
– Fever, tachypnea and tachycardia
– Encouragement of cough and use of a blow-
bottle aperatus
 POSTOPERATIVE COMPLICATIONS 9

Respiratory Compications 3
• Pulmonary Aspiration
• Postoperative Pneumonia
– Host defenses: cough reflex, the mucociliary
system, and activity of alveolar macrophages
– Gram-negative bacilli
• Posoperative Plevral Effusion and
Pneumothorax
– Subdiaphragmatic inflamation (Subphrenic
abscess ,acute pancreatitis)
– Postoperative pneumothorax
Subclavian catheter insertion,(treatment: PPV)
 POSTOPERATIVE COMPLICATIONS 10

Fat Embolism
Fat embolism is relatevely common and
asymptomatic
Fat embolism syndrom consist of neurologic
dysfunction, respirotory insufficiency, and
petechiae of the axilla, chest, and proximal arms
• Larger fat particle are trapped in the lung
cappilaries.
Lipolysis Î free fatty acids Î acute vasculitis Î
pulmonary edema Î hypoxemia Î DIC
• 12-72 hours after injury
• Decreased hematocrit, thrombocytopenia
• Treatment:PEEP+diuretics
 POSTOPERATIVE COMPLICATIONS 11

Cardiac Complications 1
• Dysrhythmias, unstable angina, heart failure, or
severe hypertension should be corrected before
surgery
• A hematocrit in the range of 30-35 % is adequate
• Dysrhythimias
– Intraoperative Dysrhythmias
– Postoperative Dysrhythmias
(Hypokalemia, hypoxemia, alkalosis, digitalis toxicity and
stress during emergence from anestesia)
– Supraventricular dysrhythmias
– Ventricular premature beats
– Postoperative trifascicular block
 POSTOPERATIVE COMPLICATIONS 12

Cardiac Complications 2
• Postoperative Myocardial Infarction
Usually appears soon after the operation,
often in association with a precipitating
factor such as hypotension, stock, or
severe hypoxemia
• The interval between the initial infarct and
the operation should be at least 6 months
(6 %)
• Postoperative Cardiac Failure
 POSTOPERATIVE COMPLICATIONS 13

Peritoneal Complications
Hemoperitoneum
Bleeding usually is the result of a technical
problem with hemostasis, coagulation defects
sometimes play a role.
Coagulopathies due to mismatched
transfusions, dilutional thrombocytopenia, and
administration of heparin.
Manifestations are hypovolemia; tachycardia,
hypotension, oliguria and peripheral
vasoconstriction
Complication of Drains
Bleeding, fistula, slippage
 POSTOPERATIVE COMPLICATIONS 14

Gastrointestinal Motility Problems

Postoperative ileus: anesthesia, manipulation,

anticholinergics, narcotics and tranquilizers.
Gastrointestinal peristalsis returns within 24 hours
Gastric peristalsis 24-48h, colonic 48-72h.
Gastric Dilatation
The patient appears ill, with abdominal distention and
hiccup
Bowel Obstruction
Postoperative adhesions or an internal hernia. 50% fallow
colorectal surgery.
Small bowel intussusception occurs in the pediatric age group
Postoperative Fecal Impaction
 POSTOPERATIVE COMPLICATIONS 15

Posoperative Hepatic Dysfunction

The incidence is greater folowing pancreatectomy, biliary bypass
operation, and portacaval shunt

Causes of postoperative jaundice

1. Prehepatic Jaundice (bilirubin overload)
Hemolysis (Drugs, tranfusions, sickle cel crisis)
Reabsorption of hematomas
2. Hepatocellular insufficiency
• Viral hepatitis
• Drug-induced (anesthesia others)
• Ischemia (shock, hypoxemia, low-output states)
• Sepsis
• Others (TPN, malnutrition)
• Liver resection (loss of parenchyma)
3. Posthepatic obstruction (to bile flow)
• Retained stones
• Injury to ducts
• Tumor (unrecognized or untreated)
• Cholecystitis
• Pancreatitis
* Benign postoperative intrahepatic cholestasis:
(Bilurubin 2-20 mg/dL, alk.phos ↑, 2-3 weeks)
 POSTOPERATIVE COMPLICATIONS 16

Postoperative Cholecystitis
• Differs in several respects from the
common form of acute cholecystitis
• It is frequently acalculous (70-80%)
• It is more common in males (75%)
• It progresses rapidly to gallbladder
necrosis; and it is not likely to respond to
conservative therapy
• More common after gastrointestinal
procedures
 POSTOPERATIVE COMPLICATIONS 17

Urinary Complications

Postoperative Urinary Retention

• Common after pelvic and perineal operations or
operations under spinal anesthesia
• Catheterization (>1000 ml=left)
Urinary Tract Infection
• Cytitis is manifested by dysuria and mild fever,
and pyelonephritis by high fever, flank
tenderness, and ileus.
Postoperative Oliguria and Renal Failure
• Oliguria: <25 ml/h in adults <1mL/kg/h in infants
• Acute Renal Failure: age>60, preexisting renal
disease, hypotension>30m, multipl transfusions
sepsis, hemolysis, nefrotoxic drugs
POSTOPERATIVE COMPLICATIONS 18

Cerebral Complications
• Postoperative Cerebrovascular Accidents
– Ischemic neural damage due to poor perfusion.

• Convulsions
– Epilepsy or metabolic derangement may lead to
convulsions in the postoperative period
POSTOPERATIVE COMPLICATIONS 19

Psychiatric Complications
• Postoperative psychosis (0,5% abdominal
operations ,meperidine, dolantin),
cimetidine and corticosteroids)
• Symtoms: confusion, fear, disorientation
as to time and place
Special Psychiatric Problems
– The ICU Syndrome
– Postcardiotomy Delirium
– Delirium Tremens
– Sexual Dysfunction
 POSTOPERATIVE COMPLICATIONS 20

Complications of IV Therapy
• Air embolism
– Embolized air lodges in the righ atrium, preventing
adequate filling of the right heart
– Hypotension, tachycardia, jugular venous distension
– Righ side up and head down
• Phlebitis
– Phlebitis is one of the most common causes of the fever
after the third postoperative day
– Induration edema and tenderness
– Prevention:
• Frequent change of tubing (48-72 h)
• Rotation of insertion sites (4 days)
 POSTOPERATIVE COMPLICATIONS 21

Postoperative Fever
Fever is a normal response to even minimal trauma,
and it is common after surgery.
¾ postoperative fever no infection, no therapy
(Resorption fever)
• Fever after 48 hours: catheter related phlebitis,
pneumonia, and urinary tract infection.
• Fever after the 5 th day: wound infection
Less common anostomotic breakdown or intra
abdominal abscesses. (Fever>39 oC=CT)
• Fever after the 1st week: Allergy to drugs,
trasfusion-related fever, septic pelvic vein
thrombosis and intra-abdominal abscesses.