Post-operative Complications

Mr J Lambert BSc. MBChB MRCS

Contents

• Introduction

• Classifications

• Case study 1

• Case study 2

• Case study 3

• Case study 4

• Quiz

• Summary

Introduction

“all expected/unexpected adverse events from leaving theatre”

Classifications

• Immediate/Early/Late

• Systemic: neurological/respiratory/cardiovascular/gastro-intestinal/urological/endocrine/haematological

Case Study 1

• you are the surgical F1(in 2 years time)

• 21 yr old female, 5 hrs post lap chole: tachycardic (110), cool peripheries, BP:90/50, Urine output 30mls/hr, complaining of abdo pain

• How would you manage this patient?

CCrISP (Care of the Critically ill Surgical Patient (Royal College of Surgeons)

Case Study 1

• you are the surgical F1(in 2 years time)

• 21 yr old female, 5 hrs post lap chole: tachycardic (110), cool peripheries, BP:90/50, Urine output 30mls/hr, complaining of abdo pain

• How would you manage this patient?

Haemorrhagic Shock

Parameters I II III IV

Bloods loss(ml)

<750 750-1500 1500-2000 >2000

Blood loss(%) <15 15-30 30-40 >40

Heart rate <100 >100 >120 >140

Blood Pressure

normal orthostatic hypotension severe hypotension

Urine output(ml)

>30 20-30 5-15 negligible

CNS symptoms

normal anxious confused obtunded

what you may see?

Case Study 2

• In 4 years time you are the surgical SHO on a busy colorectal firm

• You are called to see a 54 yr old man post anterior resection for rectal cancer.He is 2 days post op, abdomen is distended, nurse reports 1L vomiting. not passing flatus or opening bowels yet.

• How would you manage this patient?

CCrISP (Care of the Critically ill Surgical Patient (Royal College of Surgeons)

you order an abdominal film

do not confuse with

Case study 3

• your F2 colleague has asked you to chase the bloods for the previous colorectal patient. It is now day 6 and the ileus has resolved. He was ready for discharge today but has suddenly spiked a temp of 38. His abdomen has become peritonitic.

• Bloods: WCC:23 CRP:300 Creat :200 Urea:9

• How would you manage this patient?

CCrISP (Care of the Critically ill Surgical Patient (Royal College of Surgeons)

Your Registrar asks you to book a CT

Case Study 4

• Your patient is managed conservatively. It is now day 25 of his enhanced recovery? His pre-sacral collection is drained radiologically. He has a long course of antibiotics and is now fit for discharge.

• He has been complaining of diarrhoea and you notice a fruity, sickly smell and his abdominal pain has returned

• How would you manage this patient?

CCrISP (Care of the Critically ill Surgical Patient (Royal College of Surgeons)

Quiz (Spot post-operative complication diagnosis)

Summary

• Be able to classify post-op complications• Think systematically (ABCDE)• Early basic management saves lives

Thanks

• Questions• Email: joellambert@doctors.org.uk