Outpatient surgical procedures are common, and with increasing pressure for cost containment, admitted patients are being discharged earlier in their postoperative course. As a result, more patients are coming to the ED with postoperative fever, respiratory complications, GU complaints, wound infections, vascular problems, and complications of drug therapy (Table 87-1). This chapter reviews the complications common to all surgical procedures and those specific to a single procedure.
TABLE 87-1Complications of General Surgical Procedures |Favorite Table|Download (.pdf) TABLE 87-1 Complications of General Surgical Procedures
|Complication ||Important Points |
|Fever ||"Five Ws" (wind, water, wound, walking, wonder drugs) are common causes |
|Pulmonary complications || |
| Atelectasis ||<24 h, treat with pulmonary toilet, discharge unless ill or hypoxemic |
| Pneumonia ||2–7 d, polymicrobial, most require admission |
| Pneumothorax ||Multiple causes, consider expiratory views, consider needle aspiration |
| Pulmonary embolism ||Dyspnea is main symptom, high index of suspicion |
|GI complications || |
| Intestinal obstruction ||Obtain radiographs, search for causes |
| Intra-abdominal abscess ||CT diagnosis, early administration of broad-spectrum antibiotics |
| Pancreatitis ||Always consider in postoperative patients with abdominal pain |
| Cholecystitis ||Usually in older patients, can be acalculous |
| Fistulas ||Can be high output, admit if concerns over output |
|GU complications || |
| Urinary tract infection ||2–5 d, oral antibiotics, most discharged |
| Urinary retention ||Rapid catheter drainage, most discharged |
| Acute renal failure ||Prerenal, renal, and postrenal causes, most admitted |
|Wound complications || |
| Hematoma ||Caused by poor hemostasis, can drain most, but be careful with neck hematomas and hematomas after vascular surgery |
| Seroma ||Painless swelling, clear fluid, drain and discharge |
| Infection ||Open, drain, and culture specimens; be careful with wounds associated with respiratory tract, GI tract, or GU tract, or secondary to trauma |
| Necrotizing fasciitis ||Pain out of proportion to physical findings |
| Dehiscence ||Be careful with abdominal incisions (potential for evisceration) |
|Vascular complications || |
| Superficial thrombophlebitis ||Usually aseptic, provide local therapy and discharge |
| Deep venous thrombosis ||Upper and lower extremity, perform Doppler studies |
|Complications of drug therapy || |
| Diarrhea ||Consider pseudomembranous colitis |
| Drug fever ||Many drugs implicated, requires admission |
| Tetanus ||Can occur after GI surgery |
|Procedure-specific complications ||See text |
The operating surgeon should be called when one of his or her patients appears in the ED with a surgical complication. This is not just a courtesy, but provides continuity of care important for the patient's well-being.
Fever is a common presenting complaint (Table 87-2). A mnemonic for the common causes of postoperative fever is the "five Ws": wind (atelectasis or pneumonia), water (urinary tract infection), wound, walking (deep vein thrombosis), and wonder drugs (drug fever or pseudomembranous colitis).1 Respiratory complications, such as atelectasis, and IV catheter–related problems, such as thrombophlebitis, are the predominant causes of fever in the first 72 hours. Necrotizing streptococcal and clostridial infections also occur in surgical wounds early in the postoperative course.
TABLE 87-2Common Causes of Postoperative Fevers in General Surgical Patients
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