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GS10 General Surgery and Thoracic Surgery Surgical Complications Toronto Notes 2019
• systemic:male,smoking,malnutrition(hypoalbuminemia,vitaminCdeficiency),connectivetissue diseases, immunosuppression, pulmonary disease, ascites, poor nutrition, steroids, chemotherapy, obesity, and other (e.g. age, sepsis, and uremia)
• DMaloneisnotariskfactor
Clinical Features
• typicallyPOD#1-3;mostcommonpresentationsignisserosanguinousdrainagefromwound
• ±evisceration
• palpationofwoundedge:shouldnormallyfeela“healingridge”fromabdominalwallclosure(raised
area of tissue under incision)
Treatment
• placemoistdressingoverwoundwithbinderaroundabdomenandtransfertoOR
• mayconsiderconservativemanagementwithdebridementoffascialand/orskinmargins
• evisceration(alsoknownas‘burstabdomen’)isasurgicalemergency):takepatientforoperativere-
closure without abdomen binder
Urinary and Renal Complications
URINARY RETENTION
• mayoccurafteranyoperationwithgeneralanesthesiaormorecommonlyspinalanesthesia
• morelikelyinoldermaleswithhistoryofbenignprostatichyperplasia,andpatientsonanticholinergics
Clinical Presentation
• abdominaldiscomfort,palpablebladder,overflowincontinence,post-voidresidualurinevolume>100mL
Treatment
• Foleycathetertorestbladder,thentrialofvoiding
OLIGURIA/ANURIA
Etiology
• prerenalvs.renalvs.postrenal
• mostcommonpost-operativecauseisprerenal±ischemicATN
■ external fluid loss: hemorrhage, dehydration, and diarrhea
■ internal fluid loss: third-spacing due to bowel obstruction, and pancreatitis
Clinical Presentation
• urineoutput<0.5cc/kg/h,increasingCr,andincreasingBUN
Treatment
• accordingtounderlyingcause;fluiddeficitistreatedwithcrystalloid(NSorRL)
Post-Operative Dyspnea
• seeRespiratoryComplicationsandCardiacComplications,GS12
Etiology
• respiratory:atelectasis,pneumonia/pneumonitis,pulmonaryembolus(PE),ARDS,asthma,andpleural effusion
• cardiac:MI,arrhythmia,andCHF
• inadequatepaincontrol
Respiratory Complications
ATELECTASIS
• comprises90%ofpost-operativepulmonarycomplications
Risk Factors
• COPD,smoking,obesity,andelderlypersons
• upperabdominal/thoracicsurgery,oversedation,significantpost-operativepain,andpoorinspiratory
effort
Clinical Features
• low-gradefeveronPOD#1,tachycardia,crackles,decreasedbreathsounds,bronchialbreathing,and tachypnea