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
90-1 Complications of General Surgical Procedures |Favorite Table|Download (.pdf)
90-1 Complications of General Surgical Procedures
|Fever||“Five Ws” (wind, water, wound, walking, wonder
drugs) are common causes.|
|Atelectasis||<24 h, treat with pulmonary toilet, discharge unless ill
|Pneumonia||2–7 d, polymicrobial, most require admission.|
|Pneumothorax||Multiple causes, consider expiratory views, consider needle
|Pulmonary embolism||Dyspnea is main symptom, high index of suspicion.|
|Intestinal obstruction||Obtain radiographs, search for causes.|
|Intra-abdominal abscess||CT diagnosis, early administration of broad-spectrum antibiotics.|
|Pancreatitis||Always consider in postoperative patients with abdominal
|Cholecystitis||Usually in older patients, can be acalculous.|
|Fistulas||Can be high output, admit if concerns over output.|
|Urinary tract infection||2–5 d, oral antibiotics, most discharged.|
|Urinary retention||Rapid catheter drainage, most discharged.|
|Acute renal failure||Prerenal, renal, and postrenal causes, most admitted.|
|Hematoma||Caused by poor hemostasis, can drain most, but be careful
with neck hematomas and hematomas after vascular surgery.|
|Seroma||Painless swelling, clear fluid, drain and discharge.|
|Infection||Open, drain, and culture specimens; be careful with wounds
associated with respiratory tract, GI tract, or GU tract, or secondary
|Necrotizing fasciitis||Pain out of proportion to physical findings.|
|Dehiscence||Be careful with abdominal incisions (potential for evisceration).|
|Superficial thrombophlebitis||Usually aseptic, provide local therapy and discharge.|
|Deep venous thrombosis||Upper and lower extremity, perform Doppler studies.|
|Complications of drug therapy|
|Diarrhea||Consider pseudomembranous colitis.|
|Drug fever||Many drugs implicated, requires admission.|
|Tetanus||Can occur after GI surgery.|
|Procedure-specific complications||See text.|
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.
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.
Table 90-2 Common
Causes of Postoperative Fevers in General Surgical Patients
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