Complications of surgery

A. Thangamani ramalingam PT, MSc(PSY), MIAP

complications Respiratory Circulatory Wound related Joint mobility/muscle weakness Postural deformity others

Atelectasis Increased temperature, pulse &

respiratory rate Flushed/feverish patient Tightness/discomfort of the affected

side Poor chest expansion X-ray reveals collapse of lung

In first 48 hrs after surgery

Painful /impaired respiration Reflex inhibition of diaphragmatic

movement due to pain &anaesthesia Difficulty in coughing Weak abdominal muscles Cough reflex inhibition due to

analgesia Accumulation of secretions

Pneumonia Aspiration pneumonia

hemodynamics

Decreases-thrombosis, ischemia &infarction

Increases- hemorrhage, edema &hyperemia

Thrombosis/Greek-clot Increased temp Tender/swollen calf Red/shiny skin Homan’s test positive Engorged veins/edema Cord like veins Pain along the course of the vein

Deep vein thrombosis

Risk of DVT may begin during,in24-48hrs or late as 3 months of surgery

Homans' sign is a sign of deep vein thrombosis (DVT). A positive sign is present when there is pain in the calf or popliteal region with examiner's abrupt dorsiflexion of the patient's foot at the ankle while the knee is flexed to 90 degrees.

Pratt's sign is an indication of femoral deep vein thrombosis. It is seen as the presence of dilated pretibial veins in the affected leg, which remain dilated on raising the leg.

The sign was described by American surgeon Gerald H. Pratt of St. Vincent's Hospital in 1949

Wells score or criteria: (Possible score -2 to 9) Active cancer (treatment within last 6 months or

palliative) +1 point Calf swelling >3 cm compared to other calf

(measured 10 cm below tibial tuberosity) +1 point Collateral superficial veins (non-varicose) +1 point Pitting edema (confined to symptomatic leg) +1

point Previous documented DVT +1 point. Swelling of entire leg +1 point Localized pain along distribution of deep venous system

+1 point Paralysis, paresis, or recent cast immobilization of lower

extremities +1 point Recently bedridden > 3 days, or major surgery requiring

regional or general anesthetic in past 4 weeks +1 point

Alternative diagnosis at least as likely -2 points

Interpretation: Score of 2 or higher — deep vein

thrombosis is likely. Consider imaging the leg veins.

Score of less than 2 — deep vein thrombosis is unlikely. Consider blood test such as d-dimer test to further rule out deep vein thrombosis.

DVT complications(long term) Night pain Venous ulceration edema

Diagnostic tests Duplex ultra sound Venography Impedance plethysmography MRI D-dimer blood test

Prevention of DVT Heparin Warfarin Aspirin Dextran Compression devices

embolism Greek-wedge/stopper

Pulmonary embolism Increased temperature, pulse & respiratory

rate Changes in patient color Severe chest pain/dysnea Pleurisy/blood stained sputum Cough, diaphoresis, apprehension Fever Bulging neck veins Altered mental status

Clinical findings of PE ST segment depression or T wave

inversion Right axis deviation Right bundle branch block

infarction Latin-stuffed

Limb infarction is an infarction of an arm or leg. Causes include arterial embolisms and skeletal muscle infarction as a rare complication of long standing, poorly controlleddiabetes mellitus. A major presentation is painful thigh or leg swelling.

oedema General Cardiac Renal Malnutrition/star

vation

Local Inflammatory Obstructive Paralytic Gravitational hereditary

causes increased hydrostatic pressure; reduced oncotic pressure within blood vessels; increased tissue oncotic pressure; increased blood vessel wall permeability e.g. 

inflammation; obstruction of fluid clearance via the 

lymphatic system; changes in the water retaining properties of the 

tissues themselves. Raised hydrostatic pressure often reflects retention of water and sodium by the kidney.

mechanism Generation of interstitial fluid is regulated by the 

forces of the Starling equation. Hydrostatic pressure within blood vessels tends to cause water to filter out into the tissue. This leads to a difference in protein concentration between blood plasma and tissue. As a result the oncotic pressure of the higher level of protein in the plasma tends to suck water back into the blood vessels from the tissue. Starling's equation states that the rate of leakage of fluid is determined by the difference between the two forces and also by the permeability of the vessel wall to water, which determines the rate of flow for a given force imbalance. 

types Pit oedema-watery low protein content

Inflammatory oedema-thick fluid with high protein content

hemorrhage Revealed and concealed hemorrhage Primary/reactionary/secondary hemorrhage

Surgical/non surgical hemorrhage

Altered pulse & resp rate

Hemorrhagic shock Class 1-    <15% Class 2-    15-30% Class 3-    30-40% Class 4-     <40%

Blood transfusion Whole blood Packed red cells Fresh-frozen 

plasma Cryoprecipitate Platelets Prothrombin 

complex concentrates

Autologus blood

Indication Acute loss Anemia <6g/dl

Pressure soreStages Blanching Hyperemia Pressure area sore

Grades1to4

Sepsis  (from Gr. the state of putrefaction or 

decay) is a potentially deadly medical condition that is characterized by a whole-body inflammatory state (called a systemic inflammatory response syndrome or SIRS) and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues. 

Increased temp,resp.rate &heart rate Severe sepsis is the systemic inflammatory response, plus infection, plus the presence of organ dysfunction.

 A lay term for sepsis is blood poisoning, also used to describe septicemia. 

shock

The typical signs of shock are low blood pressure, a rapid heartbeat and signs of poor end-organ perfusion or "decompensation" (such as low

urine output, confusion or loss of consciousness Hypovolaemic shock Cardiogenic shock Distributive shock includes infectious,

anaphylactic and neurogenic causes

General muscle weakness Loss of mobility

Hiccough Vomiting Urine retention Abdominal distension Peritonitis Burst abdomen Paralytic ileus Renal failure

Urinary calculai UTI Incontinence Insomnia/depression Loss of appetite/weight Constipation Indigestion Less efficient immune system Sluggish liver &renal function Postural hypotension/supine hypotensive syndrome

Wound infection

Postoperative wound infection is an infection in the tissues of the incision and operative area. It can occur from 1 day to many years after an operation but commonly occurs between the fifth and tenth days after surgery.

pain, tenderness, localized swelling, redness, or heat.

microbes flourishing in the surgical site because of poor preoperative preparation, wound contamination, poor antibiotic selection, or the inability of an immuno compromised patient to fight off infection.

Factors increasing an individual's risk include malnutrition, decreased blood volume, lengthy preoperative stay, hypothermia, poor tissue perfusion, diabetes, and the use of immunosuppressant's such as steroids

Advanced age and obesity increase an individual's risk of having infection at the surgical site

Wound infection can cause separation of the wound layers, incisional hernias, abscesses, and tissue destruction (gangrene or necrotizing fasciitis), which can result in physical and/or functional deformity. Bacteria from the infection can spread, causing an overwhelming, life-threatening, systemic infection (sepsis).

Kypho-scoliosis

thank you