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Surgical Complications

Lindsey E Goldstein, MD PGY 5. Surgical Complications. Wound Thermal Regulation Postoperative Fever Pulmonary Cardiac Renal Gastrointestinal Metabolic Neurological. Surgical Complications. Primary disease Operation Unrelated factors Complications leading to other complications

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Surgical Complications

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  1. Lindsey E Goldstein, MD PGY 5 Surgical Complications

  2. Wound Thermal Regulation Postoperative Fever Pulmonary Cardiac Renal Gastrointestinal Metabolic Neurological Surgical Complications

  3. Primary disease Operation Unrelated factors Complications leading to other complications Prevention Surgical Complications

  4. Dehiscence Seroma Hematoma Infection Incisional Hernia Wound Complications

  5. Separation of facial layers Serosanguineous drainage Technical Complication Risk Factors Evisceration Wound Dehiscence

  6. Evisceration

  7. Incisional Hernia

  8. Collection of liquefied fat, serum and lymphatic fluid under the incision Benign No erythema or tenderness Mastectomy, axillary and groin dissections Treatment Seroma

  9. Abnormal collection of blood Discoloration of the wound edges (purple/blue) Blood leaks through skin sutures Imperfect hemostasis Potential for secondary infection Neck hematomas can be dangerous Hematoma

  10. Major problem Superficial Deep Organ space Most commonly occur 4-6 days post-op Erythema, tenderness, edema Wound Infection

  11. Necrotizing fasciitis Bacterial infection of underlying fascia Classically Streptococcus, most often polymicrobial with anaerobes/GNR Surgical debridement and IV antibiotics Clostridial Myositis Clostridial muscle infection (myonecrosis and gas gangrene) Clostridium perfringens Surgical debridement and IV antibiotics Wound Infection

  12. Necrotizing fasciitis

  13. Necrotizing fasciitis

  14. Necrotizing Fasciitis

  15. Hypothermia Malignant Hyperthermia Complications of Thermal Regulation

  16. Drop in body temperature of 2 degrees C Causes Body’s Response Temperature below 35 C Coagulopathic Platelet dysfunction Mild - 32 – 35C = 90-95F Mod – 28 – 32C = 82–90F Severe – 25 – 28C = 77-82F Extreme Hypothermia

  17. Rare; autosomal dominant Fever, tachycardia, rigidity, cyanosis First sign is increased end tidal CO2 Often within 30 minutes Treatment: Dantrolene, correct electrolytes, cooling blanket Malignant Hyperthermia

  18. The Six W’s Wind: pneumonia Wound: infections Water: UTI Walking: DVT (possible PE) Waste: abscess Wonder Drug: medication Noninfectious Within the first 48-72 hours Infectious Fevers POD 3-8 Standard work up includes Blood cultures UA and Urine Cultures CXR Sputum cultures Tylenol/Motrin Postoperative Fever

  19. Atelectasis Peripheral alveolar collapse due to shallow tidal breaths Most common cause of fever within 48 hours of surgery Incentive spirometry Aspiration Pneumonitis Reduced by pre-op fasting, protonix, cricoid pressure Nosocomial Pneumonia Pulmonary edema CHF ARDS Pulmonary embolus 500,000 per year 1 in 5 are fatal Prevention Pulmonary Complications

  20. ARDS

  21. Hypertension Ischemia/Infarction Leading cause of death in any surgical patient Key to treatment: prevention MONA Arrhythmias >30 seconds of abnormal cardiac activity Key to treatment is to correct underlying medical condition Cardiac complications

  22. Urinary retention Inability to evacuate a urine-filled bladder Commonly a reversible abnormality Perianal and Hernia repairs Acute Renal Failure Pre-renal Intrinsic Post-renal Renal Complications

  23. Postoperative ileus GI Bleeding Pseudomembranous colitis Ischemic Colitis Anastomotic Leak Enterocutaneous fistula Gastrointestinal Complications

  24. Lack of function without definitive obstruction Prolonged by extensive operative manipulation, SB injury, narcotic use, abscess and pancreatitis Must be distinguished from SBO Flat and Upright abdominal film Ileus: dilated bowel throughout, air in colon and rectum SBO: air fluid levels, no colonic or rectal air Postoperative Ileus

  25. Postoperative Ileus

  26. Small Bowel Obstruction

  27. GI Bleeding From Any source (get a detailed history) Gastric “stress” ulcers (Curling’s Ulcer) Uncommon with invention of H2Blockers and PPIs Pseudomembranous colitis Superinfection with C difficile Alteration of intestinal flora by perioperative antibiotics Toxic colitis is a surgical emergency (mortality of 20-30%) Ischemic Colitis Bowel affected helps determine cause Surgical devascularization, hypercoagulable states, hypovolemia and emboli Anastomotic leak Enterocutaneous fistula The most complex and challenging surgical complication Gastrointestinal Complications

  28. C diff colitis

  29. C diff colitis

  30. Anastomotic leak in GBP

  31. Adrenal Insufficiency Uncommon but potentially lethal Sudden cardiovascular collapse Hypotension, fever, confusion, abdominal pain “Stim” test, administration of hydrocortisone Baseline serum cortisol, 30 min, 60 min Hyper/Hypothyroidism SIADH Continued ADH secretion despite hyponatremia Neurosurgical procedures, trauma stroke, drugs (ACE-I, NSAIDs) Metabolic Complications

  32. Beware the drugs you will be prescribing Delirium, Dementia and Psychosis Seizure Disorders Stroke and Transient Ischemic Attacks Neurologic Complications

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