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.