Postoperative complications in the first 24 hours: a general surgery audit

BACKGROUND: Traditionally, the purpose of routine postoperative surveillance has been to detect postoperative complications. The literature reports well-documented, procedure-specific postoperative complication rates. However, there are no reports detailing the prevalence of postoperative complications in general surgical ward settings, where nurses care for patients following a variety of surgical procedures. AIMS: This paper reports an audit of the frequency and type of postoperative complications in a general surgical population occurring in the first 24 hours postoperatively. METHOD: A patient record audit was undertaken for all postoperative patients who returned to two general surgical wards. This was conducted sequentially, involving a 4 week data collection phase in each participating ward during 2001. RESULTS: The audit sample comprised 144 patient records with an average patient age of 54 years. Statistically significant results included the rate of postoperative nausea and vomiting of 37.5% (n = 54), and 17% (n = 25) of patients experiencing another 'clinical event'. LIMITATIONS: The findings reflect only those complications recorded/documented in postoperative patients' records, and cannot be generalized beyond the sample and setting. CONCLUSIONS: Postoperative patients cared for on general surgical wards experienced a high level of nausea and vomiting, while the occurrence of life-threatening complications was small.     

Kidney transplantation: a therapy option.

The growing number of patients with end stage renal disease (ESRD) choosing kidney transplantation as a therapy option has increased critical care nurses' exposure to this patient population. Critical care nurses have a crucial involvement when caring for the patient in the postoperative period or when serious complications develop. A knowledge base of immunosuppressive therapy and the body's response to it is helpful in assessing and identifying rejection, infection, and technical complications.     

Thoracoabdominal aneurysm repair: a case report

Aneurysms that extend from the descending thoracic aorta into the abdomen, which can also involve the visceral segments of the upper abdominal aorta, are traditionally classified as thoracoabdominal. Thoracoabdominal aortic aneurysm reconstruction is very complex vascular surgery associated with high postoperative morbidity and mortality and related postoperative complications. In addition to the surgical complexity associated with repair of these aneurysms, the temporary interruption of blood flow distal to the clamp introduces multiple considerations for the anesthetic practitioner to consider for the reduction of potential complications. This case report involves an 80-year-old female presenting for elective repair of a type IV thoracoabdominal aortic aneurysm, with utilization of standard invasive hemodynamic monitoring and cerebrospinal perfusion pressure monitoring as a neuroprotective measure. Hemodynamic stability was maintained via vasoactive agents, as well as compensatory vascular repletion guided by invasive monitoring. A definitive anesthetic plan based on thorough preoperative assessment, insistent intraoperative management techniques to minimize potential complications, and postoperative management of this patient allowed for successful vascular reconstruction, resulting in a positive patient outcome.     

Using evidence to enhance the recovery of patients undergoing colorectal surgery: part 1

This is the first part of a three-part series describing how an enhanced recovery clinical pathway uses a multidisciplinary team to reduce postoperative stress and complications, improve recovery, and decrease hospital length of stay without affecting patient safety for patients undergoing colorectal surgery. This part discusses patient education and discharge planning. Next month, pain and postoperative nausea and vomiting will be discussed.     

Complications of weight loss surgery: implications for critical care nursing

Weight-loss surgery (WLS) patients present a relatively new population for the health care system. Lack of clinical information about the WLS patient and the postoperative WLS patient can negatively affect quality of care and put the patient at unnecessary risk. Postoperatively, the bariatric patient is often admitted with complex care management requirements that differ from those of other surgical patients. Acute and critical care nurses must have a thorough understanding of the health implications of obesity, be familiar with common WLS procedures, and remain vigilant regarding the potential postoperative complications that can occur in this particular patient population.     

Patient care after discharge from the ambulatory surgical center

An important and often forgotten aspect of postoperative care occurs after the patient is discharged from the ambulatory surgical center. With more than 60% of all surgeries and procedures occurring on an ambulatory basis, what happens after the patient is no longer in continuous professional care is of concern to the ambulatory nurse. Numerous physical postoperative complaints are common and expected sequelae of anesthesia and surgery in the ambulatory patient. In this article, important postdischarge complications are reviewed and contemporary management options discussed. The information contained in this review article is valuable to the provider in educating patients regarding their anticipated course of postoperative recovery. OBJECTIVES: -Based on the content of this article, the reader should be able to (1) identify important postdischarge complications to provide patients with comprehensive discharge instructions regarding their continued recovery at home; (2) discuss contemporary management options available to treat postdischarge complications; (3) realize the incidence of specific postdischarge complications and how that relates to patient satisfaction with the surgical experience; (4) recognize signs and symptoms of postdischarge complications; and (5) identify risk factors of patients for developing specific complications in the postoperative phase.     

Assessing the postoperative patient: philosophy, knowledge and theory

The assessment of the postoperative patient is critical in identifying the patient's current condition and to monitor any complications that might occur. However, many nurses fail to realize the implications that philosophical paradigms, knowledge and theoretical concepts bring to the assessment practice and the manner in which assessment is conducted; in particular, within 24 h after surgery. This article seeks to explore the usefulness of philosophy, knowledge and theory as they relate to nursing assessment of the postoperative patient within the initial 24 h after surgery. It is the duty of nurses to select and effectively apply appropriate philosophical dimensions, knowledge and theories in practice and critically evaluate these areas with respect to assessment of the postoperative patient, thus aiming for a holistic assessment of the patient.     

Retinoblastoma: care and support of the pediatric patient and family

This paper presents the holistic approach to the care of the pediatric patient with strabismus. It discusses preoperative management, contemporary surgical procedures including postoperative suture adjustments, complications and the care and management of the patient and family on the pediatric unit. It reviews discharge instructions including pain management, postoperative safety and the follow-up appointment with the surgeon. Methods of determining the level of knowledge of the child's primary caregiver are also a major focus.     

Hepatic transplantation: postoperative complications

Advances in surgical techniques and immunosuppression have made orthotopic liver transplantation a first-line treatment for many patients with end-stage liver disease. The early detection and treatment of postoperative complications has contributed significantly to improved graft and patient survival with imaging playing a critical role in detection. Complications that can lead to graft failure or patient mortality include vascular abnormalities, biliary abnormalities, allograft rejection, and recurrent or post-transplant malignancy. Vascular abnormalities include stenosis and thrombosis of the hepatic artery, portal vein, and inferior vena cava, as well as hepatic artery pseudoaneurysm, arteriovenous fistula, and celiac stenosis. Biliary abnormalities include strictures, bile leak, obstruction, recurrent disease, and infection. While imaging is not used to diagnose allograft rejection, it plays an important role in identifying complications that can mimic rejection. Ultrasound is routinely performed as the initial imaging modality for the detection and follow-up of both early and delayed complications. Cholangiography and magnetic resonance cholangiopancreatography are used to characterize biliary complications and computed tomography is used to confirm abnormal findings on ultrasound or for the evaluation of postoperative collections. The purpose of this article is to describe and illustrate the imaging appearances and management of complications associated with liver transplantation.     

Observations and vital signs: ritual or vital for the monitoring of postoperative patients?

Patient surveillance during the postoperative period has traditionally consisted of the collection of routine and regulated vital signs, supported by observations of other aspects of a patient's recovery. The purpose of this research was to determine if the frequent collection of postoperative vital signs assisted in detecting postoperative complications in the first 24 hours after a patient has returned to the ward setting. The study involved: (1) a survey of policy documents; (2) observations of postoperative nursing care; and (3) an audit of medical records. Major findings revealed that vital signs are collected based on tradition and are collected routinely, and there may not be a relationship between vital-signs collection and the occurrence or detection of complications.     

Evidence-based practice: caring for a patient undergoing total knee arthroplasty

More than 500,000 total knee arthroplasty (TKA) surgeries were performed in 2006 and the number is expected to continue to increase (S. ). A background in evidence-based nursing care will assist any nurse assigned in caring for a postoperative TKA patient. Strong pain assessment and reassessment skills with an understanding of multimodal pain management benefits pain control and patient recovery from TKA surgery. Safe mobilization and therapy techniques that reflect evidence-based practice will keep patients safe. Providing nursing interventions that prevent complications from infections or thromboembolism will reduce never events from occurring. This article will present evidence for the care of a postoperative TKA patient.     

微血管减压术治疗面肌痉挛患者的围术期护理

目的探讨微血管减压术治疗面肌痉挛术后出现的并发症及围术期护理措施。方法统计微血管减压术治疗面肌痉挛的患者例数以及并发症发生情况,回顾性分析住院期间发生并发症的患者病历资料。结果 28例患者中,术后出现面瘫8例、听力下降3例、后组颅神经损伤1例、小脑损伤1例、脑脊液漏1例,通过有效的护理评估和干预,患者均顺利度过术后并发症高危期。结论精心的护理能减少并发症给患者造成的伤害和促进患者康复。     

Radiological considerations: percutaneous laser disc decompression

Diagnostic radiology is an integral part of percutaneous laser disc decompression (PLDD). All physicians involved in PLDD patient selection and treatment must be familiar with the imaging techniques unique to this procedure to ensure a successful outcome. The following review is based on the cumulative experience gained in performing over 150 PLDD procedures. It discusses the function of diagnostic radiology in all facets of PLDD including patient selection, intraoperative imaging, postoperative evaluation, and analysis of complications. Fundamental radiologic concepts that apply to PLDD are explained and protocols suggested to optimize results and avoid complications.     

CATR: a new generation of autologous blood transfusion

As the field of surgery advances and the conservative use of banked blood transfusion increases the need for postoperative autotransfusion has increased. By using the CATR, the patient's demands for blood can be more adequately met without causing further complications for the patient. This article presents one method for postoperative cardiothoracic autotransfusion and describes its advantages and risks. A Nursing Plan of Care is included.     

Using evidence to enhance the recovery of patients undergoing colorectal surgery: part 2

This is the second part of a three-part series describing how an enhanced recovery clinical pathway uses a multidisciplinary team to reduce postoperative stress and complications, improve recovery, and decrease hospital length of stay without affecting patient safety for patients undergoing colorectal surgery. Last month, patient education and discharge planning were discussed. This part discusses multimodal analgesia and standardized postoperative nausea and vomiting prophylaxis. Next month, fluids, diet, tubes and drains, and early mobilization will be discussed.     

Preadmission interventions to prevent postoperative complications in older cardiac surgery patients: A systematic review

Objective(s)

The literature on postoperative complications in cardiac surgery patients shows high incidences of postoperative complications such as delirium, depression, pressure ulcer, infection, pulmonary complications and atrial fibrillation. These complications are associated with functional and cognitive decline and a decrease in the quality of life after discharge. Several studies attempted to prevent one or more postoperative complications by preoperative interventions. Here we provide a comprehensive overview of both single and multiple component preadmission interventions designed to prevent postoperative complications.

Methods

We systematically reviewed the literature following the PRISMA statement guidelines.

Results

Of 1335 initial citations, 31 were subjected to critical appraisal. Finally, 23 studies were included, of which we derived a list of interventions that can be applied in the preadmission period to effectively reduce postoperative depression, infection, pulmonary complications, atrial fibrillation, prolonged intensive care unit stay and hospital stay in older elective cardiac surgery patients. No high quality studies were found describing effective interventions to prevent postoperative delirium. We did not find studies specifically targeting the prevention of pressure ulcers in this patient population.

Conclusions

Multi-component approaches that include different single interventions have the strongest effect in preventing postoperative depression, pulmonary complications, prolonged intensive care unit stay and hospital stay. Postoperative infection can be best prevented by disinfection with chlorhexidine combined with immune-enhancing nutritional supplements. Atrial fibrillation might be prevented by ingestion of N-3 polyunsaturated fatty acids. High quality studies are urgently needed to evaluate preadmission preventive strategies to reduce postoperative delirium or pressure ulcers in older elective cardiac surgery patients.     

Albumin-glutaraldehyde bioadhesive ("Bioglue") for prevention of postoperative complications after stapled hemorrhoidopexy: a randomized controlled trial

BACKGROUND: Hemorrhoidopexy using the circumferential stapler is an established method for surgical treatment of patients with prolapsing hemorrhoids. Despite its advantages, complications such as anal canal stenosis, hemorrhage and anastomosis leak with eventual intrapelvic sepsis can cause serious postoperative problems. The aim of this study was to evaluate the utility of a surgical adhesive, the biological albumin-glutaraldehyde glue "Bioglue", in reduction of these postoperative complications. PATIENTS AND METHODS: Between January 2002 and November 2004, 200 patients undergoing stapled hemorrhoidopexy were enrolled in a prospective, randomized clinical trial. One hundred patients were randomly assigned to the control group; the study group consisted of 100 patients who received Bioglue in the mucosa anastomosis area. All patients received standardized postoperative analgesic, laxative and antibiotic treatment. We then evaluated the two groups for postoperative complications (after surgery and 6 months postoperatively). RESULTS: From the control group (no Bioglue application), two patients presented with anal stenosis, two with hemorrhage, three had anastomosis leak and one had thrombosis, whereas none of the patients from the Bioglue group had any of these complications. Both groups had patients with severe postoperative pain (3 each) and fecal incontinence (1 patient each). The overall difference in the number of complications in the two groups was statistically significant (p < 0.05). CONCLUSION: In this first study using Bioglue in patients undergoing circumferential stapled hemorrhoidopexy we have shown that application of the glue is effective in reducing postoperative complications.     

临床护理路径在心血管急症经皮冠状动脉介入治疗术中作用的Meta分析

目的:系统评价临床护理路径在心血管急症经皮冠状动脉介入治疗(PCI)术中的作用。方法:选取2006年6月~2014年3月发表的20篇文献(共2209例试验组1068例,对照组1141例)为研究资料,以常规护理为对照,评价临床护理路径对住院时间、患者满意度和术后并发症的影响。结果:以住院时间为评价指标的文献11篇,与对照组比较,试验组的住院时间明显缩短(Z=32.33,P0.05);以患者满意度为评价指标的文献8篇,与对照组比较,试验组的患者满意度明显提高(Z=5.65,P0.001);以术后并发症为评价指标的文献14篇,与对照组比较,试验组的术后并发症明显减少(Z=9.32,P0.05)。结论:临床护理路径能减少患者住院时间和术后并发症,提高其满意度。     

Pulmonary dysfunction and surgical risk. How to assess and minimize the hazards

Postoperative deterioration of pulmonary function can be considerable, resulting in hypoxemia and atelectasis, if such effects are not anticipated and efforts made to prevent or minimize them. The risk of postoperative pulmonary complications depends on the patient's age, degree of obesity, and cigarette consumption; the type of surgery to be performed; and the anesthetic agent used. Assessment of risk is based primarily on clinical and laboratory evaluations. The tests performed may vary from patient to patient, and specialized studies of regional pulmonary function are frequently required. Even though a patient may be identified as having a high risk of postoperative pulmonary complications, risk can often be decreased through a number of preoperative and intraoperative measures as well as a postoperative therapeutic program.     

Integrating telehealth as a strategy for patient management after discharge for cardiac surgery: results of a pilot study

Advances in telecommunication technologies have improved access and availability of telehealth for use in healthcare. In cardiac care, telehealth has predominantly been used to manage patients with heart failure. The use of telehealth as a strategy for patient management after discharge for cardiac surgery can be beneficial in monitoring postoperative status and in the early detection of complications. This article provides an overview of the use of telehealth and telemanagement in cardiac patients and discusses the results of a pilot study as an example of an application of the use of telehealth for elderly cardiac surgery patients at high risk of postoperative complications.