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Postoperative Complications

Essential reading for nursing students and those who need basic awareness of surgery and possible complications.

This article is for second- and third-year nursing students. It assumes that the students have the passed all the pre-requisites to reach the second and third years. Knowing and understanding post operative complications is essential knowledge for students and qualified nurses working in hospitals.

A cursory look at the 30 day mortality figures shows that some patients die within 30 days after surgery. Some of these deaths are due to preventable complications. It is for this reason that good post operative care is essential. It should be a priority of the entire treatment team and associated professionals to prevent post operative complications.

All surgical procedures and interventions have complications. Simpler procedures involving local anaesthesia have lesser complications than major interventions involving the heart and brain. Very young children, older people, and more frail individuals are more likely to succumb to surgical interventions or their complications than younger and healthier patients.

Postoperative complications can be subdivided in many different ways. However, I have chosen to subdivide them into immediate, short term and long term complications related to surgery and anesthesia. Anesthetic complications are those which are related to the anesthesia, including hypoventilation, and changes in the level of consciousness. Surgery related complications are those which are specifically due to the procedure; Generally these are at the site of the procedure but may become systemic when the whole body becomes involved for example bacteremia and septicemia. It must be remembered that these are artificial divisions for learning purposes. In practice the patient must be seen holistically.

The table below shows the frequency of complications following major orthopedic surgery. Higher risk surgeries have more complications and less serious surgeries have fewer complications. Mortality figures from different surgeries are shown in table two at the end of this article. Prevention and early intervention can affect 30 day mortality figures and patient outcomes.

Complications Frequency (min – max)
Myocardial infarction 0.06 to 1.4 %
Pulmonary emboli 1 – 6%
Bowel obstruction 1 – 2%
Retention of urine 0,8% – 35%
Confusion 0 – 5 %

Table 1: Frequency of systemic complications after major orthopedic surgery.

During the transfer of a patient from the recovery room to the ward it is important for the nurse to have the following equipment: airway, portable supply of oxygen and a portable suction machine. This is because the patient’s breathing is compromised by anaesthesia and the surgical procedure. Walled oxygen and suctioning equipment are not available during transport. We know that the patient may need support during this time. All hospitals are equipped with portable suction machines and oxygen cylinders for this purpose. If not you should recommend this to the person in charge.

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  1. Are we required read and memorise all these complications?

  2. i ask the new reserch

  3. Good Day Yenni,

    It is my view that no student should have to memorise anything. However, nursing students should be able to look and assess patients properly. If your assessment skills are good then you will be able to prevent these complications.

    I hope these comments are helpful.

    Shergill

  4. Good Day Reza,

    I do not understand what you are asking!

  5. as a nursing student,we should memorze anything especially this complication to prevnt any serious problms.

  6. Thank yu so much, really these are things we have to know, we HEO students in PNG have to know these esp. times when we would turn to these out there in the rural areas of the country…
    tnx alot…

  7. I trained as a Nurse in the old school. We were literally required to memorise these complications. I am not saying that we should memorise them but I am saying that we should know them and be able to recognise and manage them at the time of occurance.

  8. This is the most comprehensive article I have read about postoperative complications. Thanks

  9. This article, looks like, is most suitable reading for doctors because they usually look after only one aspect of the patient. This is the wholistic approach.

  10. Quick question for you all.

    What would be the biggest post op risk factor for a 27 year old patient who is 14 weeks gestation. Reading through these I could think of quite a few but the questions makes it out like there is only ONE major risk factor….

    Thanks.

  11. Good Day Blaine,

    You are asking me a hypothetical question. Without knowing the patient’s history it will be impossible to tell. I wish I could be more helpful.

    Sincere apologies.
    Shergill

  12. HI Dr. De Souza,

    Sorry I did not respond for a long time. Missed your comment.

    I teach in a University. These articles are generally for nursing students. They have to know a lot to pass exams and look after very ill patients.

  13. Yenni, Are you still in QLD?

  14. very comprehensive. thanks for the articLe.

  15. Hi daredevil07,

    Thank You for reading and commenting on my article. I love to hear both positive and negative feedback. The positive feedback is motivating the negative forces me to think of things which I did not feel were important.

  16. we, nursing student should not only memorize this complications but to understand it more.

  17. Hi ViVi,

    Thank You for your comments. I fully agree with your comments. My feelings are a little more intense, “we should live these complications” i.e. have a feeling for how the patient will feel if she/he was experiencing any one of these complications.

    Each patient is a mother/father/brother/sister to someone else.

    Thanks.
    Shergill

  18. Hi, Shergill

    Thanks for spending time posting this article. I find it is very helpful for my nursing study.

    Although some might think nursing students should not memorize the complications. But I think for an inexperienced student nurse, the best way is to memorize and recognize these complications before we actually have the chance to learn it. Otherwise how do you know these complications when a sudden emergency happen, and you don’t have any experience?

    Anyway, thanks again.

    By the way, what are the nursing related patient risks in HDU? (I am doing an assignment about this, a bit lost)

    Melissa

  19. Hi Melissa,

    Thank you reading and commenting on this article. I appreciate the feedback I receive from students.

    What type of HDU are you in? Medical, Surgical, or mixed.
    Nursing Related risks (Care): Go through the body systems and tie the patients underlying diagnoses with all body systems.

    Hospital infections, intitutionlanized behaviour, dependence, addictions, chronic fatigue are a few of the possible complications. Don’t forget the complications of simply lying in be bed – pressure sores, chest infections, DVT, muscle atrophy etc.

    Good luck Melissa.

  20. Hi Melissa,

    Thank you reading and commenting on this article. I appreciate the feedback I receive from students.

    What type of HDU are you in? Medical, Surgical, or mixed.
    Nursing Related risks (Care): Go through the body systems and tie the patients underlying diagnoses with all body systems.

    Hospital infections, intitutionlanized behaviour, dependence, addictions, chronic fatigue are a few of the possible complications. Don\’t forget the complications of simply lying in be bed – pressure sores, chest infections, DVT, muscle atrophy etc.

    Good luck Melissa.

  21. Hey, Shergill

    I am in mixed HDU.

    Thank you so much. Those information you mentioned are exactly what I need. I have thought about infection, pressure sores, DVT. Haven’t thought about muscle atrophy, chest infection. Thank you so much.(I am so happy!)

    Here is my assignment information : ” a nursing-related patient safety event which results in actual or potential harm to the patient can be caused by direct or indirectly nursing care. Identify 5 nursing-related patient safety risks which may occur in the HDU.

    I think the risks you have mentioned are pretty much I need. Thanks again for your help and time.

    Melissa

  22. Hi Shergill,

    Thanks so much for your time. As part of my nursing study, I’m tackling the following question and would really appreciate your thoughts on it:

    Amy, aged 28 years, has undergone a bowel resection under general anaesthesia and returned to the High Dependency Unit (HDU) 4 hours ago. Amy has two suction drains in situ from her abdomen, an intravenous hydration line and a nasogastric tube on free drainage. Amy is alert and orientated.

    What changes to her heart rate, respiration rate, blood pressure, temperature and oxygen saturation may indicate uncompensated haemorrhage?
    Provide a rationale for each of your assessment findings. Describe (5) immediate nursing actions undertaken on realising Amy is haemorrhaging.

    Thanks again.
    Melissa

  23. Hi Melissa,

    Sorry I missed your comments. It is now 25th. Nov. 2009. DO you still need your question answered.

  24. Hi, shergill

    That will be nice to know the answer.
    thank you again

    Melissa

  25. i Love this article!!!
    thanx a Lot Shergill…
    We are going to have our reporting tomorrow and this is the topic assigned to me…

  26. How do you cite this article? APA wise? I don’t have your first initial or a date?!?! Thanks, Pam

  27. Hi Pam,

    Thank You for reading and citing this article. I published this article on 16th. July 2007.

    When citing from the web it is usual to give the link.

  28. I do not understand what you are asking!

  29. Thank you very much for your contribution and generous of sharing your personal experiences. I am in my year two Nursing couse doing my last term study. Normally I will refers to my teachers’ note and my Tabbener book for answer. Your sites were very relevant.

    Sandie Heong
    Singapore – woodlands

  30. Thank you very much for the above information. Can i share this to our Care Partners (CNA) for educational purposes? Thanks.

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