1. General Complications of Surgery
Dr Awad Alqahtani MD,MSc,FRCSC(Surgery)FRCSC(Oncology),FICS
Laparoscopic Bariatric Surgeon and Surgical Oncologist

2. Pre&Post Operative Care and Surgical Complications
Pre Operative evaluation :
History & Physical Examinations
Investigations and Radiologic diagnostic Tools
Routine lab, EKG, etc.

3. Pre-operative Preparation
Testing
Determines ability to sustain surgical insult
Determines type of anesthesia delivery
Blood Pressure, Diabetes, EKG, Liver function, CBC, Chest X-ray, UA
Medications
Day before surgery, anti-inflammatory
Day of surgery, antibiotics
Post op pain meds
Smoking cessation?

4. Patient/Procedure Confirmation
Surgical Consent
Pre-operative marking
“Time Out” in the operating room

5. Types of Injuries Wrong site, wrong procedure Wrong medication
Skin breakdown/decubiti
Burns
Nerve damage
Ischemia
Eyesight

6. Classification of Post Operative Complications
Avoidable (Preventible, non Preventible)
- Physiological, Biochemical ; Anemia, Coagulopathy
- Related to timing

7. Related to timing Immediate 0-24 Hrs. Anesthesia Pain Bleeding
Shock, Renal failure
Intermediate 1-30 days [avr. 7 day] (LOS)
Organ
Systems
Other Systems
Late > 30 Days, after D/C.

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

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

10. Wound Complications Dehiscence Seroma Hematoma Infection
Incisional Hernia

11. Wound Dehiscence Separation of facial layers Serosanguinous drainage
Technical Complication
Risk Factors
Mortality approaches 30%
Evisceration

12. Evisceration

13. Incisional Hernia

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

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

16. Wound Infection Major problem Superficial Deep Organ space
Most commonly occur 4-6 days post-op
Erythema, tender, edema
2.5% of abdominal incisions
Staphylococcus aureus

17. Wound Infection Necrotizing fasciitis Clostridial Myosistis
Bacterial infection of underlying fascia
Classically Streptococcus, most often polymicrobial with anaerobes/GNR
Surgical debridement and IV antibiotics
Clostridial Myosistis
Clostridial muscle infection (myonecrosis and gas gangrene)
Clostridium perfringens 17

18. Necrotizing fasciitis

19. Complications of Thermal Regulation
Hypothermia
Malignant Hyperthermia

20. Hypothermia 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

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

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

23. Pulmonary Complications
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

24. Cardiac complications
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

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

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

27. Postoperative Ileus 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

30. Gastrointestinal Complications
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

31. Metabolic Complications
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)

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