Introduction

Surgical complications impact many patients every year, and when post-operative complications occur, they can disrupt the normal healing cycle and introduce new challenges in patient care. It is estimated that between 3% and 27% of surgical patients have unforeseen complications related to their surgical event.¹

Common Post-operative Complications

Various post-operative complications can arise, and some of the more common complications include:

• Hospital-acquired infections: Hospital-acquired infections are infections that patients acquire while receiving health care. They may include surgical site infections (SSIs), catheter-associated urinary tract infections, central line bloodstream infections, pneumonia, and gastrointestinal infections. Hospital-acquired infections are among the top 10 leading causes of death in the United States and impact nearly 1.7 million patients seeking health care annually.²

• Deep vein thrombosis or pulmonary embolism: Deep vein thrombosis is a blood clot in a large vein deep inside an arm, leg, or other part of the body. When the clot breaks away from the vein and travels to the lungs, it is a pulmonary embolism, a complication that can quickly lead to death. Surgical procedures increase the risk of developing deep vein thrombosis or pulmonary embolism.³
• Wound dehiscence: Wound dehiscence is a partial or total separation of previously approximated wound edges because of a failure of proper wound healing. Dehiscence typically occurs in the early stages of healing. Prompt detection is critical in preventing worsening dehiscence, which may lead to evisceration, complete dehiscence where intra-abdominal organs herniate through the open wound.⁴

• Shock or hemorrhage: Hemorrhaging from the surgical site post-operatively can occur if the wound reopens. Rapid loss of blood from the surgical site can lead to shock, which is a severe drop in blood flow to the body.

Other potential complications that can arise post-operatively include reactions to anesthesia, pulmonary complications and difficulty breathing, and temporary problems with urine retention.⁵

Preventing Post-operative Complications

Although not all post-operative complications can be prevented, some can be avoided through vigilant care immediately after surgery and throughout the healing period. Many complications can be avoided through basic care strategies, such as the following⁶:

• Proper handwashing to avoid cross-contamination: As much as 50% of all health care–associated infections are transmitted through the hands of health care workers. Appropriate hand hygiene is the single most effective strategy to protect patients from health care–associated infections, including SSIs.⁷

• Strict adherence to surgical aseptic techniques and sterilization of all patient equipment: Sterilization techniques related to environmental cleaning, pre-operative skin preparation of the patient, surgical attire, and general techniques for working in a sterile field can minimize microbial contamination and reduce SSI rates.⁸

• Pulmonary exercises: Pulmonary exercises after surgery help to regulate breathing, thus ensuring adequate oxygenation for healing. These exercises can also clear the lungs and lower the risk of pneumonia.

• Early ambulation and leg exercises: Walking and exercising the legs as soon as possible after surgery promote the delivery of oxygen throughout the body and stimulate circulation to decrease the potential development of blood clots.

• Hydration: Proper hydration is crucial for adequate wound healing. Dehydration can contribute to poor oxygen perfusion and prevent essential nutrients from being delivered to the wound. Additionally, adequate hydration can help to prevent complications such as deep vein thrombosis and pulmonary embolism.

Health care providers can also employ certain tools when treating the wound itself in the post-operative period to prevent some of the most significant complications, such as infection.

• Localized topical treatments: These localized treatments, such as antimicrobial wound dressings and topical agents, can have a positive effect in reducing infection rates and be a strategic addition in prevention of SSIs.⁹

• Cellular or tissue-based products: These products can aid in closing dehisced surgical wounds by providing a temporary or permanent substitute for skin that serves as a barrier while healing.¹⁰

• Negative pressure wound therapy: Negative pressure wound therapy is a special dressing that is sealed over the wound and then attached to a gentle vacuum pump that draws fluid and infection away from the wound, thereby effectively managing bioburden and reducing the risk of SSI.¹¹

Conclusion

In addition to these clinical modes of preventing post-surgical complications, patient education remains vital in reducing the occurrence and severity of complications during the healing period after hospital discharge. This education should also be provided to those who may assist with caring for the patient at home. Assessing and identifying risk factors for complications are crucial in early interventions that can lead to better outcomes and faster healing of surgical wounds.¹²

References

1. Agency for Healthcare Research and Quality (AHRQ). Surgical Complication Prevention Guide. Rockville, MD: AHQR; 2017.

2. Haque M, Sartelli M, McKimm J, Baker MA. Health care-associated infections – an overview. Infect Drug Resist. 2018;11:2321-2333.

3. Edeer AD, Comez S, Damar HT, Savci A. Prevalence and risk factors of venous thromboembolism in postoperative patients: a retrospective study. Pak J Med Sci. 2018;34(6):1539-1544.

4. Rosen RD, Manna B. Wound dehiscence. StatPearls. 2019. https://www.statpearls.com/kb/viewarticle/31401. Accessed September 15, 2020.

5. John Hopkins Medicine. After surgery: discomforts and complications. 2020. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/af…. Accessed September 15, 2020.

6. Nursing CE. Postoperative complications [course material]. 2019. https://www.nursingce.com/ceu-courses/postoperative-complications. Accessed September 15, 2020.

7. Tartari E, Weterings V, Gastmeier P, et al. Patient engagement with surgical site infection prevention: an expert panel perspective. Antimicrob Resist Infect Control. 2017;6:45.

8. Gaines S, Luo JN, Gilbert J, Zaborina O, Alverdy JC. Optimum operating room environment for the prevention of surgical site infections. Surg Infect. 2017;18(4):503-507.

9. Gaspard F, Brassard P, Alam T, et al. Impact of an antimicrobial dressing in reducing surgical site infections in cardiac surgery patients. Wounds. 2013;25(7):178-185.

10. Suzuki K, ed. A guide to using cellular and tissue-based products. Podiatry Today. 2018;31(3):26-30.

11. Norman G, Goh EL, Dumville JC, et al. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev. 2020;6(6):CD009261.

12. Anderson DJ, Podgorny K, Berrios-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605-627.