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Postoperative complications may result from the primary disease, the operation, or unrelated factors. Occasionally, one complication results from another previous one (eg, myocardial infarction following massive postoperative bleeding). The clinical signs of disease are often blurred in the postoperative period. Early detection of postoperative complications requires repeated evaluation of the patient by the operating surgeon and other team members.

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Prevention of complications starts in the preoperative period with evaluation of the patient’s disease and risk factors. Improving the health of the patient before surgery is one goal of the preoperative evaluation. For example, cessation of smoking for 6 weeks before surgery decreases the incidence of postoperative pulmonary complications from 50% to 10%. Correction of gross obesity decreases intra-abdominal pressure and the risk of wound and respiratory complications and improves ventilation postoperatively.

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The surgeon should explain the operation and the expected postoperative course to the patient and family. The preoperative hospital stay, if one is necessary, should be as short as possible both to reduce costs and to minimize exposure to antibiotic-resistant microorganisms. Adequate training in respiratory exercises planned for the postoperative period substantially decreases the incidence of postoperative pulmonary complications.

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Early mobilization, proper respiratory care, and careful attention to fluid and electrolyte needs are important. On the evening after surgery the patient should be encouraged to sit up, cough, breathe deeply, and walk, if possible. The upright position permits expansion of basilar lung segments, and walking increases the circulation of the lower extremities and lessens the danger of venous thromboembolism. In severely ill patients, continuous monitoring of systemic blood pressure and cardiac performance enables identification and correction of mild derangements before they become severe.

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Hematoma

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Wound hematoma, a collection of blood and clot in the wound, is one of the most common wound complications and is almost always caused by imperfect hemostasis. Patients receiving aspirin or low-dose heparin have a slightly higher risk of developing this complication. The risk is much higher in patients who have been given systemically effective doses of anticoagulants and those with preexisting coagulopathies. Vigorous coughing or marked arterial hypertension immediately after surgery may contribute to the formation of a wound hematoma.

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Hematomas produce elevation and discoloration of the wound edges, discomfort, and swelling. Blood sometimes leaks through skin sutures. Neck hematomas following operations on the thyroid, parathyroid, or carotid artery are particularly dangerous, because they may expand rapidly and compromise the airway. Small hematomas may resorb, but they increase the incidence of wound infection. Treatment in most cases consists of evacuation of the clot under sterile conditions, ligation of bleeding vessels, and reclosure of the wound.

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Seroma

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A seroma is a fluid collection in the wound other than pus or blood. Seromas often follow operations that involve elevation of skin flaps and transection of numerous lymphatic channels (eg, mastectomy, operations in the groin). Seromas delay ...

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