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All operations come with inherent risks for postoperative complications. These range from relatively common complications, such as superficial wound infections, to other systemic complications, such as cerebrovascular accidents. All complications, however small or big, matter and increase the risk of patient mortality, longer length of stay, and readmissions. Agencies such as the Centers for Medicare & Medicaid Services (CMS) recognize the significance of these events and now tie financial reimbursements to surgical quality through several complication metrics (Table 5–1). Postoperative complications therefore impact not only patients, but also providers and healthcare systems. To reduce these complications, surgeons must be cognizant of patient risk factors, facile in diagnosing the complication, and well-versed in managing them.
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This chapter will systematically discuss both minor and major complications that may occur postoperatively. The aim will be to equip readers with the knowledge to identify, understand, and reduce postoperative complications with nonoperative and operative strategies. Such knowledge is necessary to achieve the best possible outcome for all surgical patients.
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Wound complications are common causes of early and late postoperative complications. Disruptions in the steps of the healing process may lead to the formation of seromas and hematomas, surgical site infections (SSIs), anastomotic leaks, and even wound dehiscence.
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A seroma is a localized fluid collection not containing pus or blood. Seromas are composed of serous fluid that fills an empty space following elevation of skin flaps and transection of lymphatic channels (eg, mastectomy, hernia repairs). These fluid collections delay healing and increase the risk of wound infection. Seromas may self-resolve, but if problematic, they can be electively evacuated by needle aspiration. Repeat needle aspirations may be necessary for recurrent seromas. Compression dressings can be applied to occlude lymphatic leaks and limit reaccumulation. Seromas of the groin, which are common after vascular operations, are best left to resorb without aspiration, since the risks of introducing a needle are greater than the risk associated with the seroma itself. However, should seromas persist with incisional drainage, wound reexploration is recommended with ligation of the primary source.
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A hematoma is a collection of blood and clot, typically adjacent to the surgical incision. It is a common wound complication following inadequate hemostasis. It typically presents as an elevated discoloration around the wound edges associated with swelling and discomfort. Sometimes there is bloody drainage along the incision. The incidence is higher in patients with intrinsic coagulopathy (eg, ...