Post-operative Complications (Oxford Specialist Handbooks)

500 Pages·2010·1.59 MB·English

by  David Leaper

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