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4.
Postoperative Complications (Morbidity) Account for:
1. Considerable human pain and suffering.
2. Increased cost of the health- care.
3. Can lead to postoperative death.
5. Accept that complications are best anticipated and avoided.
Recognize the incidence of co-morbidity.
Understand the importance of matching the procedure to the associated risks.
Appreciate the importance of recognizing complications early and treating them vigorously.
6.
Can be generally applicable to all the procedures OR specific to the operations.
Age both extremes (Very young & Very old)
Obesity
7.
Co-morbid conditions:
? Cardiovascular diseases
? Respiratory diseases
? DM
? Renal diseases
? Metabolic factors
? Infections
? Wound healing
? Peripheral vascular diseases
8.
Drug therapy (Concurrent drugs used)
[Steroids, Immunosuppressant, Antibiotics]
Blood transfusion
9.
Obstructive Jaundice
Neoplastic Diseases
10.
Minimally Invasive Surgery
Orthopedic Surgery
Gynaecology
Thoracic & Upper Abdominal Surgery
Prolonged Operations
11.
Complications of surgery may broadly be classified as those:
I. Due to Anesthesia
II. Due to Surgery
12.
The anesthetic complications depend upon the mode (General, Regional & Local) and types of anesthetic (the anesthetic agent toxicity).
13. (A) LOCAL ANESTHESIA:
Injection site:
Pain, haematoma, Nerve trauma, infection
Vasoconstrictors:
Ischemic necrosis
Systemic effects of LA agent: Allergic reactions, toxicity
14. (B) SPINAL, EPIDURAL & CAUDAL ANESTESIA:
Technical failure
Headache due to loss of CSF
Intrathecal bleeding
Permanent N. or spinal cord damage
Paraspinal infection
Systemic complications (Severe hypotension)
15. (C) GENERAL ANESTESIA:
Direct trauma to mouth or pharynx.
Slow recovery from anesthesia due to drug interactions OR in-appropriate choice of drugs or dosage.
Hypothermia due to long operations with extensive fluid replacement OR cold blood transfusion.
16.
Allergic reactions to the anesthetic agent:
? Minor effects
eg: Postoperative nausea & vomiting
? Major effects
eg: Cardiovascular collapse, respiratory depression)
Haemodynamic Problems:
Vasodilation & shock
17.
Perioperative:
Haemorrhage, organ damage, electro-cautery related etc…
Postoperative complications which may be considered under 2 headings:
I. Immediate OR early
II. Late Specific (Procedure Related):
18. Respiratory:
? Collapse, consolidation, aspiration etc.
Cardiovascular:
? Haemorrhage (Primary, Reactionary, Secondary)
? Shock (Hypovolemic, septic, cardiogenic, neurogenic)
? Myocardial infarction
? Deep venous thrombosis
19.
Thromboembolic
Septic:
? Wound, abscess collections
Gastrointestinal:
? Intestinal obstruction
? Anastomotic leakage, intraabdominal abscess formation, enterocutaneous fistulae
Wound complications:
? Infections, dehiscence, etc.
20. Renal:
? Oliguria, acute renal failure
Hepatic:
? Jaundice, hepatocellular dysfunction/ insufficiency
Cerebral:
? Psychological, Neuropsychiatric complications (delirium, etc.)
Drug-related:
? Anesthetic, antibiotics, specific medical disease treatment toxicity
Nerve injuries:
? Compression, traction, cautery, severed, etc.
21.
Wound:
? Hypertrophic scar, keloid, wound sinus, implantation dermoids, incisional hernia
Adhesions:
? Intestinal obstruction, strangulation
Altered anatomy/Pathophysiology:
? Bacterial overgrowth, short gut syndrome, postgastric surgery syndromes, etc.
Susceptibility to other diseases:
? Malabsorption, incidence of cancer, tuber- culosis, etc.
