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.
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
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
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.
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.
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.
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 ...