5. Postoperative Care and Complications

I. Postoperative Care

• Goal: Safe recovery after surgery/anesthesia → Detect complications early
• Most important period: First 24-48 h
• Principle: Observe trends, not only single values

1. Precise Observation

• Temperature
• BP, pulse, respiratory rate, O2 saturation
• Breathing: Airway, dyspnea, cough/sputum, aspiration/atelectasis/PE signs
• Mental state: Consciousness, delirium, agitation
• Fluid balance: IV/oral intake, urine output, drain/NG/stoma losses
• Urination + stool: Retention, oliguria, flatus, bowel movement, ileus signs
• Drains → Position, patency, quality + amount

• Quality: Blood, bile, pus, feculent, pancreatic/serous fluid

• Wound: Bleeding, hematoma, swelling, erythema, discharge, dehiscence, pain
• Catheters/cannulas: IV line, urinary catheter, epidural, oxygen/tubes → Infection, thrombosis, extravasation

2. Pain, Mobilization and Nutrition

• Pain control: Regular assessment + multimodal analgesia
• Avoid excessive opioids → Respiratory depression, ileus, nausea/vomiting, delirium
• Respiratory care: Deep breathing, coughing, incentive spirometry/physiotherapy
• Early mobilization: Sit up, stand, walk, active/passive limb movement as soon as safe
• Physiotherapy → Prevents DVT/PE, atelectasis, pneumonia, ileus, pressure ulcer, muscle loss
• Early enteral/oral nutrition as tolerated according to operation type

3. Thrombosis / VTE Prophylaxis

• Purpose → Prevent DVT and PE, especially in high-risk patients
• Assess VTE risk + bleeding risk
• Mechanical: Elastic compression stockings, intermittent pneumatic compression pump
• Movement: Early mobilization, active/passive movement of extremities
• Medications: UFH, LMWH, DOAC in selected operations according to protocol

4. Wound, Drain and Catheter Care

• Sterile dressing changes
• Drain output monitoring → Remove when safe
• Urinary catheter/cannula care → Remove unnecessary lines early
• Escalate warning signs: Tachycardia, hypotension, fever, oliguria, increasing pain, dyspnea, confusion

II. Postoperative Complications

• Postoperative complication: Unwanted event after surgery/anesthesia → Delayed recovery, morbidity or mortality
• Classify by timing or by cause/system

Classification by Timing

• Immediate (0-24 h): Bleeding, shock, airway obstruction, aspiration, anesthetic complications, acute MI/arrhythmia
• Early (1-7 d): Atelectasis, pneumonia, SSI, UTI, ileus, anastomotic leak, DVT/PE, urinary retention, delirium
• Late (>7 d): Abscess, fistula, wound dehiscence, incisional hernia, anastomotic stricture/leak, malnutrition

Surgical Complications

• Bleeding: Tachycardia, hypotension, falling Hb, bloody drain output → Resuscitation + hemostasis/reoperation if ongoing
• Anastomotic leakage: Fever, tachycardia, abdominal pain, peritonitis/sepsis, abnormal drain content
• Ileus: Distension, nausea/vomiting, no flatus/stool → Mobilization, reduce opioids, correct electrolytes, NG tube if needed
• Peritonitis: Diffuse abdominal pain, guarding, fever, ileus, sepsis → Source control
• Fistula: Abnormal communication; intestinal content may appear from wound/drain
• Sepsis: Infection + organ dysfunction → Resuscitation + antibiotics + source control

Wound Healing Disorders

• Hematoma: Blood collection → Pain, swelling, infection risk
• Seroma: Serous/lymph fluid collection
• Wound infection / SSI: Redness, warmth, swelling, pain, purulent discharge, fever
• Wound dehiscence: Partial/complete wound disruption
• Incisional hernia: Late fascial failure → Protrusion at scar

• Risk factors: Infection, obesity, DM, malnutrition, anemia, steroids, smoking, cough, ascites

Non-Surgical / Systemic Complications

1. Respiratory System

• Atelectasis
• Aspiration
• Pneumonia
• Pleural effusion, pulmonary edema
• PE: Sudden dyspnea, tachycardia, chest pain, hypoxia
• ARDS

2. Cardiovascular System

• Arrhythmia
• Heart failure
• Acute MI
• Hypertensive crisis
• Thrombosis, embolism
• Shock: Hypovolemic, septic, cardiogenic, obstructive

3. Others

• Acute renal failure / AKI: Oliguria, rising creatinine
• Urinary retention, UTI
• Fever: Evaluate timing and source
• Delirium: Elderly, infection, hypoxia, pain, opioids, electrolyte disorder
• PONV: Risk of dehydration, aspiration and wound stress

Prevention Summary

• Good surgical technique + hemostasis + asepsis
• Early mobilization + respiratory physiotherapy + VTE prophylaxis
• Fluid/electrolyte/glucose monitoring + early enteral nutrition
• Remove unnecessary catheters, drains and lines early
• Escalate early warning signs quickly