Postoperative complicationsComplications after surgery

Introduction/Definition

The term postoperative complications covers all problems that occur after an operation and can be very serious. Some of the complications require intensive medical monitoring and rapid therapy. Furthermore, postoperative complications do not always occur immediately after the operation, but often within 2 to 14 days afterwards. The occurrence of postoperative complications can be avoided to a large extent by

  • The exclusion of some risk factors,
  • A good monitoring and
  • Optimal surgical planning.

Risk factors

There are some preoperative factors that make the occurrence of postoperative complications much more likely. These include: All these risk factors should be assessed in a detailed admission interview before the operation in order to be able to take appropriate measures before, during and after the operation. Problems can also arise during the operation, which significantly increase the occurrence of postoperative complications.

These include But also a long duration of the operation, the opening of several body cavities and large blood losses can lead to postoperative complications. Also postoperatively some circumstances can lead to complications. Here, too, inadequate volume delivery, removal of the ventilation tube too early and inadequate monitoring are significant factors in the occurrence of complications. Inadequate physiotherapeutic breathing therapy, poor hygiene and electrolyte derailment can also lead to serious complications.

  • A high age,
  • Malnutrition or obesity,
  • Diabetes mellitus
  • High blood pressure, vascular stenosis
  • Chronic obstructive pulmonary diseases,
  • Nicotine or alcohol abuse,
  • Renal insufficiency or heart disease.
  • An insufficient volume,
  • An insufficient respiratory and circulatory monitoring or
  • Severe fluctuations in blood pressure.

Complications affecting the lungs

The functionality of the lungs is a decisive factor in recovery and the occurrence of complications. Especially early physiotherapeutic respiratory therapy can prevent pneumonia or other complications. Pleural effusion is an accumulation of water between the lung and the lung membrane.

On the one hand, it can occur in cases of heart failure and then leads to bilateral symptoms. A unilateral pleural effusion occurs reactively after removal of the spleen, partial removal of the liver or as a result of any infection in the abdominal cavity. Clinically, a pronounced pleural effusion leads to shortness of breath and smaller collapsed lung sections.

Smaller pleural effusions are not initially noticeable. In the case of effusions of less than 200ml per side, it is not necessary to drain the fluid with a needle (puncture), otherwise the puncture should be performed under ultrasound guidance. A pneumothorax is the collapse of a lung, usually postoperatively after application of a central venous catheter or as a result of long-term ventilation.

During this procedure, the pleura, the lung skin, is punctured so that air flows into the pleural gap and compresses the lung from the outside. Depending on its severity, the pneumothorax is accompanied by shortness of breath and increased heart rate. It can be diagnosed by side examination and palpation of the lung and requires rapid treatment.

This consists of a thoracic drainage system. With the help of the drainage, the air is released from the pleural space and the lung can expand again. Atelectasis means a collapsed section of the lung.

A segmental or main bronchus is usually displaced by a plug of mucus, more rarely by blood or a foreign body. As a result, the affected area is still supplied with blood, but oxygen can no longer be absorbed in this area. This results in reduced breathing activity on the affected side.

The diagnosis is mainly symptom-oriented and is made by percussion and auscultation. The therapy is carried out by appropriate positioning to loosen the obstructing mucus plug. In addition, tapping and vibration therapy.

At the same time, medication is administered to dissolve the secretion. Pneumonia is a pneumonia, which is one of the main complications after an operation. It is often caused by insufficient ventilation during postoperative pain and insufficient respiratory activity.Pneumonia can also occur during long-term ventilation.

Clinically it comes to fast and shallow breaths, fever, sputum when coughing and shortness of breath. The therapy consists of a distinctive physiotherapeutic breathing therapy to completely ventilate the lungs. Antibiotics are also administered.

Respiratory insufficiency is a respiratory disorder and is one of the main complications, as it leads to an oxygen deficiency in all organs. The oxygen saturation drops and sometimes the CO2 concentration increases at the same time. Symptomatically, this leads to respiratory distress, which manifests itself with superficial pantomimetic breathing, cyanosis (blue coloration of skin and mucous membranes), confusion, restlessness and anxiety.

Therapy is initially the administration of oxygen through so-called oxygen goggles. If this measure does not lead to a sufficient increase in saturation, the patient must be given mechanical ventilation. Close monitoring of the blood gases is indispensable, as well as permanent control of the oxygen saturation.

Pulmonary embolism is one of the most dangerous postoperative complications. The cause is deep leg or pelvic vein thrombosis due to insufficient blood flow or insufficient exercise. For this reason, all patients whose mobility is severely restricted postoperatively are treated with thrombosis prophylaxis.

If this blood clot breaks loose, it is transported into the large pulmonary veins, where it moves a large bronchus. This suddenly leads to massive shortness of breath with breath-dependent pain, an increase in heart rate and a drop in blood pressure. The therapy consists of oxygen administration and dissolving the clot with the help of anticoagulant drugs in therapeutic doses. If therapy is inadequate, pulmonary embolism can be fatal. More about this important topic on our pulmonary embolism page.