Surgical Complication

Perioperative Fever Infection or Inflammation -injury -catheters -UTI -pneumonia -surgical sites -thrombophlebitis -drug reactions

Fever Day 1 Atelectasis -pulmonary physiotherapy Systemic symptoms -severe wound complication -intestinal leakage

Fever Day 2 Catheter related problem Respiratory complication

Fever Day 3 Wound infection UTI, pneumonia Thrombophlebitis Drug reaction

Fever Day >7 Anastomosis leakage Intraabdominal abscess Deep wound infection

Wound Complication Wound infection Wound hematoma Wound seroma Wound dehiscence

Wound Infection Wound classification -clean wound 3-4% -clean-contaminated wound 7-8% -contaminated wound 10% -dirty wound 30%

Factor Wound Infection Age DM patient Steroid use Obesity Duration of operation Malnutrition Hypothermia

Wound Hematoma Inadequate hemostasis Coagulopathy Aspirin user Post-op thyroidectomy ---- airway obstruction

Wound Seroma Axillary dissection

Wound Dehiscence Separation of fascia +/- evisceration Salmon-colored fluid post-op day 4 + evisceration----- operation - evisceration------ incision hernia

Factor Technical error Hypoproteinemia Morbid obesity Malignancy Uremia COPD DM Suture material

Postoperative Ileus Non-mechanical obstruction -manipulation -infection -abnormal eletrolyte -opiate -hypoalbuminemia

Post-op Ileus Small-bowel 24 hr Stomach 48 hr Large-bowel 72hr

Thyroidectomy Postoperative bleeding -airway obstruction Recurrent laryngeal nerve injury -unilateral; hoarseness -bilateral; airway obstruction External branch of superior laryngeal nerve

Thyroidectomy Hypoparathyroidism -<8mg/dl -numbness, tingling -tetany -convulsion -respiratory stridor -chvostek”s sign, trouseau”s sign -prolong Q-T , S-T interval

Thyroidectomy Thyroid storm -severe hyperthyroidism -high mortality rate Symptom ;high fever ;conscious change ;GI dysfunction ;Atrial tachy-arrhythmia

Thyroidectomy Hypothyroidism Trachea and esophagus injury keloid

Breast Surgery Hemorrhage and hematoma Seroma Wound infection Skin flap necrosis Frozen shoulder Injury to thoracodorsal nerve -latissimus dorsi -internal rotation and abduction

Breast Surgery Injury to long thoracic nerve -serratus anterior -winged scapula Injury to intercostobrachial nerve Injury to axillary vein and artery Pneumothorax Lymphedema

Groin Hernia Hemorrhage Transection of spermatic cord Severance of nerves Severance of testicular blood supply Femeral vein constriction Severance of vas deferens Damage to intestine Injury to urinary bladder and ureter

Groin Hernia Post-op -urinary retention -scrotal ecchymosis -swollen testis -testicular atrophy -hydrocele -wound infection -neuroma -recurrence

Nerve Ilioinguinal nerve -base of penis, upper scrotum, adjacent thigh Iliohypogastric nerve -suprapubic area Genitofemeral nerve -cremasteric muscle, skin of penis and scrotum, upper lateral thigh Femeral nerve -extensor muscle group of thigh

Splenectomy Intraabdominal bleeding Intraabdominal abscess Pancreatic leakage/ fistula Portal Vein Thrombosis Overwhelming postsplenectomy sepsis