Postoperative Complications Detection

Timeline & Alerts - Trouble Timing

• Wind (Lungs)
• Water (UTI)
• Wound (SSI)
• Walking (DVT/PE)
• Wonder drugs

⭐ Immediate post-op fever (within hours) is often due to cytokine release from surgical trauma, not infection.

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Cardio-Pulmonary Issues - Systemic Sabotage

• Pulmonary Complications:

  • Atelectasis: Most common (24-48h post-op). Fever, ↓O₂, basal crackles. Prevent: Incentive spirometry.

    ⭐ Atelectasis is the most common pulmonary complication in the first 24-48 hours post-surgery.

  • Pneumonia: Fever, cough, purulent sputum, ↑WBC. Usually after >48h.
  • Pulmonary Embolism (PE) & DVT:
    • 📌 Virchow's Triad: Stasis, hypercoagulability, endothelial injury.
    • Wells Score (DVT/PE): Assesses risk (cancer, immobility, surgery, tenderness, swelling). Score >2 = high probability.
    • Suspect PE: Sudden dyspnea, pleuritic chest pain, tachycardia.

• Cardiovascular Complications:

  • Perioperative MI: Often silent. ECG changes (ST elevation/depression), ↑cardiac enzymes (Troponin). Risk factors: CAD, HTN.
  • Arrhythmias: Atrial fibrillation common. Monitor ECG.
  • Heart Failure: Dyspnea, orthopnea, JVD, edema.

GI & GU Complications - Leaks & Blocks

• Postoperative Ileus (POI)
  • Transient ↓bowel motility; resolves 2-5 days.
  • N/V, distension, no flatus/stool. Rx: Supportive.
• Anastomotic Leak
  • Breakdown of surgical join; often 5-7 days post-op.
  • Signs: Tachycardia, fever, pain, ↑WBC. Dx: CT contrast.

  ⭐ Persistent unexplained tachycardia is often the earliest sign of an anastomotic leak.

• Postoperative Bowel Obstruction (POBO)
  • Early (<30d) or late (>30d); adhesions common.
  • Colicky pain, vomiting, distension. Dx: X-ray, CT.
• Postoperative Urinary Retention (POUR)
  • Inability to void; bladder scan > 400-600 mL.
  • Rx: Catheterization.
• Acute Kidney Injury (AKI)
  • Causes: Pre-renal (hypovolemia), renal, post-renal.
  • Dx: ↑SCr ($≥$ 0.3 mg/dL in 48h or 1.5x baseline), ↓Urine Output.
• Urinary Tract Infection (UTI)
  • Catheter-associated common.
  • Dysuria, frequency, fever. Dx: Urinalysis, culture.

Wound & Fever Workup - Incision Issues

Surgical Site Infections (SSIs) are key concerns.

⭐ Staphylococcus aureus is the most common causative organism for SSIs.

SSI Classification (CDC Criteria):

Post-operative Fever Causes (📌 5 W's):

• Wind (Pulmonary): Days 1-2 (Atelectasis, Pneumonia)
• Water (UTI): Days 3-5
• Wound (SSI): Days 5-7 (Signs: erythema, warmth, discharge, pain; earlier if severe, e.g., necrotizing)
• Walking (DVT/PE): Days 7-10
• Wonder drugs/Other: Anytime

Fever Workup:

High‑Yield Points - ⚡ Biggest Takeaways

• Post-op fever timing is key: Atelectasis (Day 1-2), UTI (Day 3-5), Wound Infection (Day 5-7), DVT/PE (Day 7+).
• Wound dehiscence: fascial separation. Evisceration: visceral protrusion.
• Atelectasis is commonest; prevent with incentive spirometry and early mobilization.
• DVT: unilateral leg swelling/pain; diagnose with Doppler ultrasound. Prophylaxis is vital.
• Paralytic ileus: absent bowel sounds, distension. Prolonged ileus warrants investigation.
• Anastomotic leak: fever, tachycardia, abdominal pain. High mortality.
• Postoperative delirium: common in elderly; assess for hypoxia, infection, metabolic causes.