The document discusses various common post-operative complications that can occur. It describes how the first post-operative assessment establishes a baseline and identifies any issues from transfer to the ward. Potential early complications within the first 2 days include fever, while issues between days 3-5 can include bronchopneumonia or sepsis. Specific wound complications like seroma, hematoma and dehiscence are also outlined. Other risks reviewed are oliguria, altered sensorium, DVT and potential pulmonary embolism. The document provides details on signs, symptoms and management approaches for each of these post-surgical complications.

1. Submitted By…
M.Abdullah
3rd Year O.T.T

2. Learning Objectives…
 Wound complications
 Seroma
 Haematoma
 Wound Dehiscence
 SSI
 Oliguria
 Altered sensorium
 DVT
 Pulmonary embolism

3. First Post-operative Assessment…
 The first postoperative assessment should take place
immediately after surgery on return to the ward.
 It provides
 A baseline against the patient’s condition.
 Identifies problems occurred on transfer from the
operating department.
 Respiratory status
 Mental status

4. Post-operative Complications …
Days……..(0-2)
 Fever
Days……( 3-5 )
 Bronchopneumonia.
 Sepsis
 Drip site infection
 Abscess formation

5. After 5 days:
 Specific complications related to surgery
eg. fistula formation.
After the first week:
 Haemorrhage
 Wound infection.
 UTI.
 DVT.

6. Wound Complications….
 Seroma
 Haematoma
 Wound Dehiscence
 SSI (Surgical Site Infections)

7. Seroma…
 Collection of liquid , serum and lymphatic fluid under
the incision. Mostly yellow fluid.
 Localised and swelling.
 Place drain during surgery/ aspiration.
 Hematoma…
 Abnormal collection of blood, usually in a potential
space in abdominal cavity.

8. Wound Dehiscence…
 Separation of ant. abd. wound involving the
anterior fascia and deeper layers.
 Causes….
 Pat. with poor nutrition , obesity.
 Increased intra-abd. pressure.
 Hemorrhage
 Infection
 Poor suture technique
 Drain and stoma placed along incision.
Treatment….. Occlusive dressing

9. Wound Infection….
 Major factors:
1) Breaks in surgical technique
2) Host parasite relationship
 Potential sources of contamination:
1) Patients themselves
2) Operating room and personnel.
 Organisms:
1) S. aureus
2) E. coli, Bacteroides , Proteus, Klebsiella ,
Pseudomonas.

10. Pulmonary infections:
1. Atelectasis
2. Aspiration pneumonia
Urinary tract infection:
Indwelling urinary catheter
 E. coli, Pseudomonas, klebsiella
Intra-abdominal infection:
Abdominal abscess
 Sites:
1. Sub-phrenic ---> most common
2. Pelvis
3. Liver
 Treatment: drain ---> explor lap / needle aspiration

11. Wound Infections…
 Most common form is superficial wound infection
occurring within the first week.
 Presenting as
 Localised pain
 Redness and slight discharge usually caused by skin
staphylococci.

12.  Cellulitis and Abscesses…
 Most present within the first week
 But can be seen as late as the third postoperative week, even
after leaving hospital.
 Present with fever and spreading cellulitis or abscess.
 Cellulitis is treated with antibiotics.
 Abscess requires suture removal and probing of the wound but
deeper abscess may require surgical re-exploration. The wound
is left open in both cases to heal by secondary intention.

13.  Gas Gangrene …..
 Is uncommon and life-threatening.
 Wound Sinus…
 A late infectious complication from a deep chronic
abscess that can occur after apparently normal healing.
 It usually needs re-exploration to remove non-
absorbable suture or mesh, which is often the
underlying cause.

14. Disordered wound healing…
 Most wounds heal without complications.
 Factors which may affect healing rate are:
 Poor blood supply.
 Excess suture tension.
 Long-term steroids.
 Immunosuppressive therapy.
 Radiotherapy.
 Severe rheumatoid disease.
 Malnutrition and vitamin defi.

15. Oliguria….
 Urine volume less than 1ml/kg/hr or <400ml /day.
 This may be the result of fluid and blood loss.
 Considered acute renal failure.
 There is an increased release of aldosterone and ADH in the first
24 hours after surgery. This results in both salt and water retention.
 Causes…..
1. Catheter obstruction
2. Pre-renal failure
3. Electrolyte Imbalance (hyperkalemia)
4. Hemodialysis

16. Management of Oliguria….
 Minimal acceptable output is 1 ml/kg/hr
 Take records of fluid intake and output.
 If oliguria is associated with other symptoms of fluid depletion,
it should be treated initially with a fluid challenge.
 Exclude obstruction of the urinary tract like urinary catheter.
 Diuretics (NSAIDS), Dopamine should not be used .

17. Altered Sensorium….
• Sensorium…
Ability of the brain to receive
and interpret sensory stimuli.
• Good Sensorium = Alertness +Awareness
• Altered Sensorium….
• Not a disease but a symptom.
• Altered sensorium can be determined by evaluating
level of consciousness.

18. Some Common Terms in Altered Sensorium….
 Confusion..
 Impaired attention and concentration,
 Manifest disorientation in time, place and person,
impersistant thinking, speech etc.
 Delirium…
 Disturbed state of mind characterized by restlessness ,
illusion , confusing speech and thinking.
 Amnesia…
 Loss of past memories and to an ability to form new ones,

19.  Dementia…
 Memory loss.
 Phychosis….
 Refers to a mental state often
described as involving a "loss of
contact with reality".

20. Initial Actions….
 Assessment of the ABC's.
 Cardiac monitoring and pulse oximetry .
 Supplemental oxygen
 Bedside glucose testing
 Intravenous access (Dextrose)
 Consider naloxone administration if narcotic overdose is
suspected.

21. Neurologic Status….
 Checked by GCS scale.
Treatment…. ‘’TONG’’
T=Thiamine , O=oxygen
N = Naloxone , G= Glucose

22. DVT …….
 Post operative Immobilisation
 Prolonged bed rest
 Usually occurs within 6 days post op.
 Signs and symptoms of DVT….
 Edema ,
 Redness,
 Warmth ,
 Prolonged dull pain,
 Low grade fever,

23.  Investigations…
Doppler
DVT Prophylaxis….
• Graduated compression stockings
• • Intermittent pneumatic compression
• • Aspirin
• • Heparin
• • Vitamin K antagonists (warfarin, acenocoumarol,
phenindione, and dicoumarol)
• • Fondaparinux

24. Pulmonary Embolism…
 No specific signs and symptoms.
 Dyspnoea, chest pain, hemoptysis , CVS collapse
tachycardia, or dysarrhythmia.
 Investigations….
 Oxygen saturation, CXR, ECG, CT Chest
 Pulmonary Angiography

25. Pulmonary Embolism…
 Management…
 Supplemental O2
 Maintain vitals
 Anticoagulants
 Embolectomy (surgical removal of embolus)

26. Thank you....