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Surgery LO's > Complications of Surgery > Flashcards

Complications of Surgery Flashcards

1
Q

What can surgical complications be divided into?

A

Immediate (<24hours)
Early (1 day - 1 month)
Late (>1 month)

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2
Q

What are the immediate complications of surgery?

A

Oropharyngeal trauma from intubation
Surgical trauma to local structures
Primary or reactive haemorrhage

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3
Q

What are the early complications of surgery?

A 
Secondary haemorrhage
VTE
Urinary retention
Atelectasis and pneumonia
Wound infection and dehiscence
Antibiotic associated colitis
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4
Q

What are the late complications of surgery?

A

Scarring
Neuropathy
Failure or recurrence

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5
Q

What are the classifications of haemorrhages?

A

Primary
Reactive
Secondary

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6
Q

What is a primary haemorrhage?

A

Continuous bleeding starting during surgery

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7
Q

What is reactive haemorrhage?

A

Bleeding at the end of surgery, or early post-op

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8
Q

What is reactive haemorrhage secondary to?

A

Increased CO and BP

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9
Q

What is secondary haemorrhage?

A

Bleeding >24 hours post-op

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10
Q

What is secondary haemorrhage usually due to?

A

Infection

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11
Q

What are the causes of post-op urinary retention?

A

Drugs
Pain
Psychogenic

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12
Q

What drugs can cause post-op urinary retention?

A

Opioids
Epidural/spinal
Anti-AChM

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13
Q

How does pain lead to urinary retention?

A

Sympathetic activation leads to sphincter contraction

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14
Q

What are the risk factors for post-op urinary retention?

A 
Male 
Older age
Neuropathy
BPH
Surgery type
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15
Q

Give two examples of causes of neuropathy that might cause post-op urinary retention

A

Diabetes

Alcoholic

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16
Q

Give two examples of surgery types with increased risk of post-op urinary retention

A

Hernia

Anorectal

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17
Q

What is involved in the conservative management of post-op urinary retention?

A

Privacy
Ambulation
Void to running taps or in hot bath
Analgesia

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18
Q

What is done if conservative management for post-op urinary retention fails?

A

Catheterise, with or without gent 2.5mg/kg IV stat

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19
Q

What might be done if a patient fails TWOC?

A

May be sent home with silicone catheter and urology follow up as outpatient

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20
Q

How common is pulmonary atelectasis post-operatively?

A

Occurs after nearly every GA

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21
Q

Why does pulmonary atelectasis occur post-operatively?

A

Anaesthetics increase mucus production and reduce mucociliary clearance, and pain inhibits respiratory excurison and cough, causing mucus plugging and absorption of distal air, leading to collapse

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22
Q

What increases the risk of post-up pulmonary atelectasis?

A

Pre-op smoking

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23
Q

When does post-op pulmonary atelectasis occur?

A

Within first 48 hours

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24
Q

What are the signs and symptoms of post-operative pulmonary atelectasis?

A

Mild pyrexia
Dyspnoea
Dull bases with reduced air entry

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25
Q

How is post-operatively pulmonary atelectasis managed?

A

Good analgesia to aid coughing

Chest physiotherapy

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26
Q

When do post-op wound infections occur?

A

5-7 days post op

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27
Q

What organisms cause post-op wound infection?

A

S. aureus

Coliforms

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28
Q

What are the operative classifications, regarding risk of wound infections?

A

Clean
Clean/cont
Contaminated
Dirty

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29
Q

What is a clean operation?

A

Incision of uninfected skin without opening viscus

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30
Q

What is a clean/cont operation?

A

Intra-operative breach of viscus, but not colon

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31
Q

What is a contaminated operation?

A

Breach of viscus, and spillage or opening of colon

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32
Q

What is a dirty operation?

A

Operation on site already contaminated by faeces, pus, or trauma

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33
Q

What are the pre-operative risk factors for wound infection?

A

Older age
Comorbidities, e.g. diabetes
Pre-exisiting infection, e.g. appendix perforation
Patient colonisation, e.g. nasal MRSA

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34
Q

What are the operative risk factors for wound infection?

A

Op classification and wound infection risk high

Longer duration

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35
Q

What are the post-operative risk factors for wound infection?

A

Contamination of wound from staff

36
Q

How are wound infections managed?

A

Regular wound dressing
Abx
Abscess drainage

37
Q

When does wound dehiscence present?

A

10 day post-op

38
Q

What is wound dehiscence preceded by?

A

Serosanguinous discharge from the wound

39
Q

What are the pre-operative risk factors for wound dehiscence?

A 
Increasing age
Smoking
Obesity, malnutrition, or cachexia
Co-morbidities 
Drugs
40
Q

What co-morbidities increase the risk of wound dehiscence?

A

Uraemia
Chronic cough
Cancer
Diabetes mellitus

41
Q

What drugs increase the risk of wound dehiscence?

A

Steroids
Chemotherapy
(Radiotherapy)

42
Q

What operative factors affect the risk of wound dehiscence?

A

Length and orientation of incision
Closure technique
Suture material

43
Q

What post-operative factors affect the risk of wound dehiscence?

A

Increased intra-abdominal pressure
Infection
Haematoma/seroma formation

44
Q

Give an example of a post-operative cause of increased intra-abdominal pressure?

A

Prolonged ileus leading to distention

45
Q

How is wound dehiscence managed?

A

Replace abdominal contents and cover with sterile soaked gauze
IV antibiotics
Opioid analgesia
Call senior and arrange theatre for repair

46
Q

What IV antibiotics are given in wound dehiscence?

A

Cef + met

47
Q

What is involved in surgical repair of wound dehiscence?

A

Wash bowel
Debride wound edges
Close with deep, non-absorbable sutures

48
Q

What might a repaired wound dehiscence require post-operatively?

A

VAC dressing or grafting

49
Q

What are the complications of cholecystectomy?

A 
Conversion to open
CBD injury
Bile leak
Retained stones
Fat intolerance/loose stools
50
Q

What is the rate of conversion to open in cholecystectomy?

A

5%

51
Q

What is the rate of CBD injury in cholecystectomy?

A

0.3%

52
Q

What are the early complications of inguinal hernia repair?

A

Haematoma/seroma formation
Intra-abdominal injury
Infection
Urinary retention

53
Q

What is the rate of haematoma/seroma formation in inguinal hernia repair?

A

10%

54
Q

What is the rate of infection in inguinal hernia repair?

A

1%

55
Q

What are the late complications of inguinal hernia repair?

A

Recurrence
Ischaemic crisis
Chronic groin pain/paresthesia

56
Q

What is the rate of recurrence in inguinal hernia repair?

A

<2%

57
Q

What is the rate of ischaemic orchitis in inguinal hernia repair?

A

0.5%

58
Q

What is the rate of chronic groin pain/paresthesia in inguinal hernia repair?

A

5%

59
Q

What are the complications of appendectomy?

A

Abscess formation
Fallopian tube trauma
Right hemicolectomy

60
Q

Why might a right hemicolectomy be required in appendicitis?

A

For carcinoid or caecal necrosis

61
Q

What are the early complications of colonic surgery?

A 
Ileus 
AAC
Anastomotic leak
Enterocutanoeus fistulae
Abdominal or pelvic abscess
62
Q

What are the late complications of colonic surgery?

A

Adhesions leading to obstruction

Incisional hernia

63
Q

What are the causes of a post-op ileus?

A

Bowel handling
Anaesthesia
Electrolyte imbalance

64
Q

How does a post-op ileus present?

A

Distention
Constipation, with or without vomiting
Absent bowel sounds

65
Q

How is a post-op ileus managed?

A

IV fluids and NGT

TPN if prolonged

66
Q

What are the complications of anorectal surgery?

A

Anal incontinence
Stenosis
Anal fissure

67
Q

What are the complications of small bowel surgery?

A

Short bowel syndrome

68
Q

At what length of bowel might a patient get short bowel syndrome?

A

<250cm

69
Q

What are the complications of a splenectomy?

A

Gastric dilatation
Thrombocytosis leading to VTE
Infection with encapsulated organisms

70
Q

How is gastric dilation following splenectomy prevented?

A

NGT

71
Q

What are the complications of arterial surgery?

A

Thrombosis and embolisation
Anastomotic leak
Graft infection

72
Q

What are the complications of aortic surgery?

A 
Gut ischaemia
Renal failure
Aorto-enteric fistula
Anterior spinal syndrome leading to paraplegia
Emboli leading to distal ischaemia
73
Q

What are the complications of breast surgery?

A

Arm lymphoedema
Skin necrosis
Seroma

74
Q

What are the complications of urological surgery?

A

Sepsis

Uroma

75
Q

How can urological surgery cause sepsis?

A

Instrumentation leading to infected urine

76
Q

What is a uroma?

A

Extravasation of urine

77
Q

What are the complications of prostatectomy?

A

Urinary incontinence
Erectile dysfunction
Rectograde ejaculation
Prostatitis

78
Q

What are the complications of thyroidectomy?

A

Wound haematoma leading to tracheal obstruction
Recurrent laryngeal nerve trauma leading to hoarse voice
Hypoparathyroidism leading to hypocalcaemia
Thyroid storm
Hypothyroidism

79
Q

What % of patients who have a thyroidectomy have transient voice hoarseness?

A

1.5%

80
Q

What % of patients who have a thyroidectomy have permanent voice hoarseness?

A

0.5%

81
Q

Which of the recurrent laryngeal nerves is more commonly damaged in thyroidectomy, and why?

A

Right, because its more medial

82
Q

What are the complications of a tracheostomy?

A

Stenosis
Mediastinitis
Surgical emphysema

83
Q

What are the complications of fracture repair?

A

Mal or nonunion
Osteomyelitis
AVN
Compartment syndrome

84
Q

What are the complications of a hip replacement?

A 
Deep infection
VTE
Dislocation 
Nerve injury 
Leg length discrepancy
85
Q

What nerves might be damaged in hip replacement?

A

Sciatic

Superior gluteal nerve

86
Q

What are the complications of cardiothoracic surgery?

A

Pneumothorax or haemothorax

Infection

87
Q

What infections might you get in cardiothoracic surgery?

A

Mediastinitis

Empyema

Surgery LO's (10 decks)

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