1. Postoperative Complications Lindsey E Goldstein, MD PGY 4

2. Always consider... What operation did the patient have? What are the most common complications of this operation? What is most life-threatening? What comorbidities does that particular patient have?

3. GO SEE THE PATIENT!

4. Hypotension 1. Hemorrhage 2. Hemorrhage 3. Hemorrhage 4. Medications 5. Normal blood pressure 6. Under resuscitation 7. Sepsis

5. Sepsis SIRS Sepsis- SIRS with an infectious source Severe sepsis- sepsis with new onset organ failure Septic shock- circulatory collapse despite resuscitation

6. Wound Complications Surgical site infection: infections of the tissues, organs, or spaces exposed by surgeons during performance of an invasive procedure –Superficial v Deep –Necrotizing soft tissue infection Hematoma Seroma Dehiscence Evisceration

7. Postoperative Fever - within 24 hours: atelectasis, not clearing secretions - 24-48 hours: respiratory complications - always consider lines and tubes

8. Urinary Complications Oliguria - hypovolemia - depressed cardiac function - diuretic dependence - retention - obstruction Hyperkalemia Urinary tract infection

9. Respiratory Complications Atelectasis Pneumonia Aspiration Pulmonary Edema ARDS Pleural effusion

10. Respiratory Complications Pulmonary embolism- tachycardia, shortness of breath, new onset arrhythmia Venous thromboembolism- high risk patients include elderly, malignancy, immobilized orthopedic patients Prevention- pharmacological (subQ heparin, lovenox, arixtra) PLUS sequential compression devices and graduated compression stockings

11. GI Complications Ileus versus small bowel obstruction Anastomotic leak Fistulas GI bleeding Abscess

12. Cardiac Complications Arrhythmia Atrial fibrillation Sinus tachycardia Ventricular arrhythmias Ischemia- MI Hypertension- pain, rebound hypertension, volume overload, hypoxia

13. Neurologic Complications Stroke Neuroma Peripheral motor and sensory deficits