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Outpatient surgical procedures are commonplace, and with increasing pressure for cost containment, admitted patients are being discharged earlier in their postoperative course. As a result, more patients are coming to the ED with postoperative fever, respiratory complications, GU complaints, wound infections, vascular problems, and complications of drug therapy (Table 90-1). This chapter reviews the complications common to all surgical procedures and those specific to a single procedure.

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Table 90-1 Complications of General Surgical Procedures
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The operating surgeon should be called when one of his or her patients appears in the ED with a surgical complication. This is not just a courtesy, but provides continuity of care important for the patient’s well-being.

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Fever is a common presenting complaint (Table 90-2). A mnemonic for the common causes of postoperative fever is the “five Ws”: wind (atelectasis or pneumonia), water (urinary tract infection), wound, walking (deep vein thrombosis), and wonder drugs (drug fever or pseudomembranous colitis).1 Fever during the initial 24 hours is usually caused by atelectasis. However, necrotizing streptococcal and clostridial infections also occur in surgical wounds early in the postoperative course. Respiratory complications, such as atelectasis, and IV catheter–related problems, such as thrombophlebitis, are the predominant causes of fever in the first 72 hours.

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Table 90-2 Common Causes of Postoperative Fevers in General Surgical Patients

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