This article is for second- and third-year nursing students. It assumes that the students have the passed all the pre-requisites to reach the second and third years. Knowing and understanding post operative complications is essential knowledge for students and qualified nurses working in hospitals.
A cursory look at the 30 day mortality figures shows that some patients die within 30 days after surgery. Some of these deaths are due to preventable complications. It is for this reason that good post operative care is essential. It should be a priority of the entire treatment team and associated professionals to prevent post operative complications.
All surgical procedures and interventions have complications. Simpler procedures involving local anaesthesia have lesser complications than major interventions involving the heart and brain. Very young children, older people, and more frail individuals are more likely to succumb to surgical interventions or their complications than younger and healthier patients.
Postoperative complications can be subdivided in many different ways. However, I have chosen to subdivide them into immediate, short term and long term complications related to surgery and anesthesia. Anesthetic complications are those which are related to the anesthesia, including hypoventilation, and changes in the level of consciousness. Surgery related complications are those which are specifically due to the procedure; Generally these are at the site of the procedure but may become systemic when the whole body becomes involved for example bacteremia and septicemia. It must be remembered that these are artificial divisions for learning purposes. In practice the patient must be seen holistically.
The table below shows the frequency of complications following major orthopedic surgery. Higher risk surgeries have more complications and less serious surgeries have fewer complications. Mortality figures from different surgeries are shown in table two at the end of this article. Prevention and early intervention can affect 30 day mortality figures and patient outcomes.
| Complications |
Frequency (min - max) |
| Myocardial infarction |
0.06 to 1.4 % |
| Pulmonary emboli |
1 - 6% |
| Bowel obstruction |
1 - 2% |
| Retention of urine |
0,8% - 35% |
| Confusion |
0 - 5 % |
Table 1: Frequency of systemic complications after major orthopedic surgery.
During the transfer of a patient from the recovery room to the ward it is important for the nurse to have the following equipment: airway, portable supply of oxygen and a portable suction machine. This is because the patient's breathing is compromised by anaesthesia and the surgical procedure. Walled oxygen and suctioning equipment are not available during transport. We know that the patient may need support during this time. All hospitals are equipped with portable suction machines and oxygen cylinders for this purpose. If not you should recommend this to the person in charge.
Post Operative Complications: Immediate
Medications used to anesthesia patients decrease the patient's respiratory rate and tidal volume. This may result in the patient having low levels of oxygen in the blood. This is called hypoxemia. In severe cases this will lead to confusion, palpitations, and irregular heartbeats. Severe hypoxia may result in coma and death of the patient. Follow the principles of airway, breathing and circulation (ABC) checks. It is routine to check these parameters. If the patient is coughing and clearing his throat it is a good sign. It means that his gag reflex is intact and that he has the strength to clear his airway. Make sure that the patients color is good, that lung expansion is equal bilaterally and that oxygen saturation is above 95% at all times.
Nurses caring for patients who are anesthetised must not leave any patient under any circumstances. Such patients must always be connected to a pulse oxymeter, cardiac monitor and a respirator unless the patient is being wakened following surgery.
If you as a Student Nurse accompany a Registered Nurse to receive a patient from the operating theater note the procedures being performed very carefully. Note how the Recovery Room Nurse formally hands over the patient to the Ward Nurse. Usually, the receiving nurse has to sign that she has received the patient. This implies that the patient is fit to be transferred to the ward. So if you are the nurse receiving the patient you must not agree to take the patient back to the ward if he is not breathing satisfactorily or is not sufficiently awake. Other reasons for not taking the patient back to the ward include excessive bleeding and unsatisfactory vital signs.
Low Blood Pressure or hypotension
This is another complication which is seen frequently. It may be the result of a number of intra operative situations. These include bleeding, movement of fluids, certain medications, heart failure, and infection. A patient who is hypotensive is likely to complain of light-headedness, confusion and generalized weakness. If hypotension is severe it may lead to abnormal cardiac rhythms, coma and death. Take the patient's blood pressure carefully before you transfer him to the ward. If he is hypotensive correct this condition before taking him to the ward. If the situation is not correctable the patient may need closer observation by a special nurse or may need to be transferred to the High Dependency Unit or the Intensive Care Unit.
