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Post-operative Complications (Oxford Specialist Handbooks) PDF

500 Pages·2010·1.59 MB·English
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OXFORD MEDICAL PUBLICATIONS Post-operative Complications Oxford Specialist Handbooks published and forthcoming General Oxford Specialist Oxford Specialist Handbooks in Handbooks Neurology A Resuscitation Room Guide Epilepsy Addiction Medicine Parkinson’s Disease and Other Hypertension Movement Disorders Perioperative Medicine, Second Stroke Medicine Edition Oxford Specialist Handbooks in Post-Operative Complications, Paediatrics Second Edition Pulmonary Hypertension Paediatric Dermatology Renal Transplantation Paediatric Endocrinology and Diabetes Oxford Specialist Handbooks in Paediatric Gastroenterology, Anaesthesia Hepatology, and Nutrition Cardiac Anaesthesia Paediatric Haematology and Day Case Surgery Oncology General Thoracic Anaesthesia Paediatric Intensive Care Neuroanaethesia Paediatric Nephrology Obstetric Anaesthesia Paediatric Neurology Paediatric Anaesthesia Paediatric Palliative Care Regional Anaesthesia, Paediatric Radiology Stimulation and Ultrasound Paediatric Respiratory Medicine Techniques Oxford Specialist Handbooks in Oxford Specialist Handbooks in Psychiatry Cardiology Child and Adolescent Psychiatry Adult Congenital Heart Disease Old Age Psychiatry Cardiac Catheterization and Oxford Specialist Handbooks in Coronary Intervention Radiology Cardiac Electrophysiology Cardiovascular Magnetic Resonance Interventional Radiology Echocardiography Musculoskeletal Imaging Fetal Cardiology Pulmonary Imaging Heart Failure Oxford Specialist Handbooks Nuclear Cardiology in Surgery Pacemakers and ICDs Cardiothoracic Surgery Valvular Heart Disease Colorectal Surgery Oxford Specialist Handbooks in Hand Surgery Critical Care Liver and Pancreatobiliary Surgery Advanced Respiratory Operative Surgery, Second Edition Critical Care Oral Maxillofacial Surgery Otolaryngology and Head and Oxford Specialist Handbooks in Neck Surgery End of Life Care Paediatric Surgery End of Life Care in Dementia Plastic and Reconstructive Surgery End of Life Care in Nephrology Surgical Oncology End of Life in the Intensive Care Urological Surgery Unit Vascular Surgery Oxford Specialist Handbooks Post-operative complications Second Edition Edited by David Leaper Visiting Professor Department of Wound Healing Cardiff University, UK Iain Whitaker Plastic, Reconstructive and Burns Surgery Welsh Centre for Burns and Plastic Surgery Morriston Hospital Swansea, UK 1 1 Great Clarendon Street, Oxford OX2 6DP Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offi ces in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York © Oxford University Press, 2010 The moral rights of the author have been asserted Database right Oxford University Press (maker) First edition published 2003 Second edition published 2010 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose this same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Cataloging in Publication Data Data available Typeset by Cepha Imaging Private Ltd., Bangalore, India Printed in China on acid-free paper by Asia Pacifi c Offset Limited ISBN 978–0–19–954626–8 10 9 8 7 6 5 4 3 2 1 Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misap- plication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding. v Preface As we started to compile this second edition of Post-operative Complications we felt it important to defi ne what a complication is. If you perform a PUBMED search using the phrase ‘surgical complication(s)’, depending over how long a period you search, over 900 articles will be returned. Despite their importance and prevalence, there seems to be no agreed defi nition. An appropriate defi nition has been devised by Adedeji et al., in their article ‘Ethics of Surgical Complications’, which we felt was appropriate: A surgical complication is any undesirable, unintended, and direct result of surgery affecting the patient which would not have occurred had the surgery gone as well as reasonably hoped. Adedeji et al., World Journal of Surgery, 2009 Complications following surgical procedures are associated with signifi - cant morbidity and mortality, add immensely to the psychological burden of the patient, and are disappointing for the surgical team. Unfortunately they are a fact of life, although we should continue to strive for the lowest incidence. Recent research has led to a greater understanding of the response to surgery and anaesthesia, and great advances have been made in pre-operative preparation with appropriate investigations and pharma- cological prophylaxis. These have reduced the incidence of many compli- cations, but the risks are impossible to remove completely. In addition, patients are increasingly aware of the risks and complications of surgery, and are keen to help to minimize their risk in whatever way they can. Information and ‘league tables’ regarding surgical success rates are increasingly available in various forms. However, these should be viewed with caution, as they are not always adjusted to allow for patient co-morbidities or the level of surgical diffi culty. Things are rarely black and white in surgery. Regular audits should be undertaken by surgical teams in order to opti- mize patient care and to learn lessons where possible. Doctors are more aware of the power of EBM (evidence-based medicine) than they may have been some years ago. All surgeons will hopefully be aware of the Cochrane database, which collates best evidence, and adhere to the ever- expanding guidance and protocols emanating from the National Institute for Health and Clinical Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN). Most surgical expertise is still passed on by apprenticeship, experience, reading peer-reviewed journals and continuing medical education. Although the expectations of surgery by the general public are increasing, surgical trainees are spending less time learning, particularly in the operating theatre, than ever before. The impact of the European Working Time Directive (EWTD) and changes in surgical training will no doubt produce a different type of surgeon. Nevertheless, he or she must not only be aware of all the potential complications for each procedure performed, but also how to minimize the occurrence of such complications. vi PREFACE This handbook is aimed at educating medical undergraduates, surgical trainees, and multi-disciplinary theatre and ward staff with regard to both general complications and those complications associated with specifi c procedures. We believe it will help medical staff to consent and counsel patients, and care givers to have a greater understanding. ISW DJL 2009 vii Foreword Complications are an important cause of morbidity and mortality after surgery. They are feared by surgeons and patients alike; surgeons because they feel they have let their patient down, and patients, relatives and carers as they have been let down. In addition there is an extra cost to our health service in terms of the need for additional care, and delayed return to home and work for the patients, which can be devastating and hard to measure. Many complications are avoidable, and the introduction of ‘fl ight lists’ as used by the airline industry has been shown to reduce errors and attendant complications. The Safer Surgery Saves Lives cam- paign, promoted by the World Health Organization, has been tested and proved to be a great advance. Following the use of this checklist there is a consequent reduction in deaths and injuries with less likelihood for system errors and lack of communication, and litigation (outlined in Chapter 24), which may follow complications after surgery. The reduction in complica- tions after surgery and improvement of the quality of care refl ects my recommendations in the NHS High Quality Care for All report. The authors have built on the previous handbook from the popular Oxford Specialist Handbook series by combining the complications after surgery in general in the fi rst half of the book, followed by complications after specialty surgery in the latter half. The majority of surgical specialties are represented, including gastrointestinal, cardiothoracic and peripheral vascular surgery, orthopaedic, urological, ENT, and plastic surgery. In using free text and checklists the authors have avoided too much repetition so the reader is able to dip into appropriate sections for rapid answers and advice. There are few textbooks available to offer information on complica- tions after surgery, how to avoid and recognise them, and how to treat them when they occur. Training and education are essential to ongoing improvements in healthcare and it is encouraging to see the authors focus on this aspect of the surgical pathway. This specialist handbook is com- prehensive, up-to-date, logically presented and should be a useful pocket book, with wide appeal, for trainee surgeons, medical students, and allied professions. Professor the Lord Darzi of Denham KBE This page intentionally left blank ix Contents Contributors xi Symbols and abbreviations xv Section 1 General complications 1 Post-operative pain 3 2 Infection 29 3 Cardiovascular complications after surgery in general 57 4 Complications related to fl uid and electrolyte management in surgical patients 85 5 Complications of nutrition 99 6 Complications of blood transfusion and coagulation 113 7 Pressure sores 125 8 Complications related to use of medicines in surgery 133 Section 2 C omplications after specifi c types of surgery 9 Complications of gastrointestinal surgery 159 10 Complications of peripheral vascular surgery 203 11 Complications after cardiothoracic surgery 231 12 Complications of abdominal transplant surgery 279 13 Complications of thoracic outlet decompression and thoracoscopic sympathectomy 289 14 Complications of vascular interventional radiology 295

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Complications following surgical procedures are not only associated with significant morbidity and mortality, but also add immensely to the psychological burden of the patient and are disappointing for the surgical team. Recent research has led to a greater understanding of the response to surgery a
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