Lecture 2

Surgical rehabilitation
Post-operative complication
Understanding the risks of surgery:
No surgery is risk-free, but understanding the possible complications can help patient make
a better decision. Immediately before surgery, the surgeon will meet with patient and
explain the potential risks for surgery. This process is called "informed consent" and is
necessary.
One of the best ways to lower risk is to choose a surgeon who performs the procedure
regularly in a facility that is familiar with both the surgeon and the surgery.

Post-operative discomfort

The amount of discomfort following surgery depends on many things, including the type of
surgery performed. Typical discomforts may include:
 Nausea and vomiting from general anesthesia
 Sore throat (caused by the tube placed in the windpipe for breathing during surgery)
 Soreness, pain, and swelling around the incision site
 Restlessness and sleeplessness
 Thirst
 Constipation and gas (flatulence)

Common surgical risks:

Shock: Shock may be caused by blood loss, infection, brain injury, or metabolic
problems. Treatment may include any or all of the following:

 Stopping any blood loss

 Helping with breathing (with mechanical ventilation if needed)
 Reducing heat loss
 Giving intravenous (IV) fluids or blood
 Providing oxygen
 Prescribing medicines, for example, to raise blood pressure

Hemorrhage. Hemorrhage means bleeding. Rapid blood loss from the site of surgery,
for example, can lead to shock. Treatment of rapid blood loss may include:

 IV fluids or blood plasma

 Blood transfusion
 More surgery to control the bleeding

Wound infection and Wound dehiscence, Delayed healing after surgery:

When bacteria enter the site of surgery, an infection can result. Infections can delay healing.
Wound infections can spread to nearby organs or tissue, or to distant areas through the blood
stream. Treatment of wound infections may include:

Some patients take longer to heal than others, particularly people with more than one
illness, such as Diabetics who have surgery typically have a longer healing time, especially
if blood sugar levels are poorly controlled.

 Antibiotics
 Surgery or procedure to clean or drain the infected area

Deep vein thrombosis (DVT) and pulmonary embolism (PE). Together, these conditions
are referred to as venous thromboembolism (VTE). This term is used because the
conditions are very closely related. And, because their prevention and treatment is also
closely related. A deep vein thrombosis is a blood clot in a large vein deep inside a leg,
arm, or other parts of the body. Symptoms are pain, swelling, and redness in a leg, arm, or
other area

The reason these clots develop, has to do with three possible factors.
--Stasis, or lack of movement of blood in the legs during surgery as Muscle relaxants that
are used as part of general anesthesia can increase the size of patient's leg veins during
anesthesia — causing cracks in the vein lining — and they can slow blood flow out of the
legs, both of which can result in DVT,
---Hypercoagulability, increased clotting in the blood which could be due to genetic
disorders, or stress.
----Injury to the blood vessels themselves.

Pulmonary embolism. The clot can separate from the vein and travel to the lungs. This
forms a pulmonary embolism. In the lungs, the clot can cut off the flow of blood. This is a
medical emergency and may cause death.

Symptoms are :

 chest pain
 trouble breathing
 coughing (may cough up blood)
 sweating
 fast heartbeat
 fainting.

- Treatment depends on the location and size of the blood clot. It may include:

 Anticoagulant medicines (blood thinners to prevent further clotting)

 Thrombolytic medicines (to dissolve clots)
 Surgery or other procedures

Breathing problem. Most patients can be removed from the ventilator at the end of
surgery.
Some patients can require the ventilator longer. Such as those with pulmonary diseases,
 smokers, patients who are chronically ill and patients who required ventilator support prior
to surgery. pulmonary complications arise due to lack of deep breathing and coughing
exercises within 48 hours of surgery. They may also result from pneumonia or from
inhaling food, water, or blood, into the airways. Symptoms may include wheezing, chest
pain, fever, and cough (among others).

Urinary retention or decrease urine output. Temporary urine retention, or the inability to
empty the bladder, may occur after surgery. Caused by the anesthetic, urinary retention is
usually treated by the insertion of a catheter to drain the bladder until the patient regains
bladder control. Sometimes medicines to stimulate the bladder may be given. decrease urine
output could be as a result of dehydration
Reaction to anesthesia. Although rare, allergies to anesthetics do occur. Symptoms can
range from mild to severe. Treatment of allergic reactions includes stopping specific medicines
that may be causing allergic reactions. Also, administering other medicines to treat the allergy.

Pressure sores due to lack of mobility .

Death due to surgery
Injury During Surgery:
during surgery there is a risk that parts of the body may be damaged .
For example, a patient having surgery to remove their appendix may have an accidental
injury to the intestine, which is attach to the appendix.
This sort of injury may be detected during the procedure and treated immediately or may
become an issue during recovery when medical staff detects the problem.

Paralysis caused by surgery:

paralysis is uncommon but can happen during brain and spinal surgery.
Depending on the nature and location of the surgery, the risk may be greater.
Poor results after surgery:
A poor surgical outcome can include severe scarring, the need for additional surgery or a
procedure that does not provide the desired results.
Numbness and tingling after surgery:
Many patients experience numbness and tingling around their surgical site, for some it is a
temporary condition.
Creating an incision requires the surgeon to cut through nerves, which send messages
between the body and the brain.If enough nerves are cut the area surrounding the surgical
site may have numbness or a tingling sensation.Depending on the location of the damage,
the nerve may regenerate, allowing sensation to return to the area over the course of weeks
or months.In other cases, damage to the nerves may be too great for the body to repair,
resulting in permanent numbness or tingling.
Scarring after surgery:
Scarring after surgery is not always preventable, especially when a large incision or
multiple incisions must be made.
In elective surgery such as plastic surgery, an obvious scar can be a much larger issue as the
surgery is typically done in a place that is visible to others.
Patients have a significant responsibility for the prevention of scarring. Following
instructions from the surgeon is essential.
Swelling and bruising after surgery:
Surgical site bruising and swelling are considered normal parts of the healing process after
surgery.
The severity can be influenced by many factors including the type of surgery, the amount of
force required to complete the surgery, the type of the patient and the type of care given
after surgery.

So we can classify post op complication into :

A-Immediate
1) Primary hemorrhage
2) Basal atelectasis: minor lung collapse.
3) Shock: blood loss, acute myocardial infarction, pulmonary embolism septicemia ,
4) Low urine output ( dehydration(
5) Injury during surgery

B-Early

1) Pain and Acute confusion: dehydration , sepsis ,pain , sleep disturbance, medication or
metabolic disturbances.
2) Nausea and vomiting: analgesia or anaesthetic-related; paralytic ileus.
3) Fever .
4) Secondary haemorrhage: often as a result of infection.
5) Pneumonia, lung atelectasis
6) Wound dehiscence or infection
7) DVT , pulmonary embolism
8) Acute urinary retention + Urinary tract infection (UTI)
9) Pressure sores.

C. Late

1) Bowel obstruction due to fibrous adhesions.

2) Incisional hernia.
3) Persistent sinus.
4) Recurrence of reason for surgery - eg, malignancy.
5) Keloid formation.
6) Cosmetic appearance