No matter how technically skilled a surgeon is, there is always a risk of complications from surgery. Complications cost the health care system millions of dollars and can cost the patient grief, pain and anguish. Though most surgeries will yield a good result, sometimes patients do not recover to full preoperative function or develop problems related to undergoing surgery.
Wound Complications
A variety of complications can occur when a surgical wound is created to give the surgeon access to the internal organs.
Wound dehiscence is one such complication. It refers to the postoperative separation of the deep tissue layers, which then allows the inner body contents to leak from their cavity. This complication often necessitates reoperation and treatment to prevent and/or treat infection.
Wound infections are another complication. Infection can set in on superficial layers of the skin at the surgical site, in deep tissues or in the organs of the body. This complication is usually treated with antibiotics, but can often necessitate surgical management such as drainage or debridement (the removal of infected tissue). If the infection spreads to the bloodstream, it is known as sepsis, a dangerous complication that can result in massive organ dysfunction.
Pulmonary Complications
Lung function can be affected postoperatively for a variety of reasons including obesity, pain from an incision and residual anesthetic effects. Atelectasis, the collapse of the tiny air sacs (alveoli) in the lung, is a common post-surgical complication. If not aggressively managed, it can result in the additional complication of pneumonia. Patients can develop pneumonia from aspirating stomach contents into the lungs, which causes chemical damage to lung structures or infection. Another complication is pulmonary embolism, which occurs when a blood clot lodges in the pulmonary artery, impeding lung circulation. It can result in decreased blood pressure stability and decreased oxygenation of blood, thereby causing damage to other organs.
Cardiac Complications
Heart attack is another complication that usually occurs within 48 hours of surgery. Patients can be screened before surgery for risk factors and pre-existing heart disease, and can be monitored post-surgery, depending on their risk classification. Patients with pre-existing heart disease are also at risk for heart rhythm disturbances after surgery, as well as the development of congestive heart failure.
Urine Retention
Difficulty voiding the bladder can occur for a variety of reasons including damage to nerves, effects of anesthesia, or increased pain and discomfort after surgery. Usually it is transient and the patient can be managed by catheterization until normal function returns.
Gastrointestinal Complications
There are a variety of complications that can occur with the gastrointestinal system. Bowel function can take a while to return after surgery, a condition referred to as "ileus." It can be brought on by trauma to abdominal structures, anesthetic effects, and various other factors, most of which are poorly understood. Trauma to the gastrointestinal organs such as the bile duct or bowels is also possible as is bleeding in the gastrointestinal system. These complications aren't always apparent until they become significant enough to cause other symptoms, such as increased heart rate or low blood pressure. Fistula formation is also a problem after some surgeries as there could be leakage between two organs, a condition that carries a high risk for infection.
Neurologic Complications
Delirium is a common complication after surgery and can be caused by a variety of factors such as residual anesthetic effect, fear of the surgery and confusion at waking up in an unfamiliar environment. Strokes can also occur post-operatively and are most commonly seen in patients undergoing cardiac surgeries.
References
- "Sabiston Textbook of Surgery, 18th Edition;" Townsend; 2007
- American Journal of Surgery. "Adverse outcomes in surgery: redefinition of postoperative complications." Fry D, Pine M, Jones B, Meimban R. Volume 197, Issue 4 (April 2009)
