One-page cheat sheet
Post-operative complications
Know them by the day they appear
palsurgery.comFree surgical teaching
Fever by day
- Day 0–2: inflammatory response, atelectasis
- Day 3–5: chest or urinary infection, line infection
- Day 5–7: wound infection, anastomotic leak, collection
- Day 5 onward: DVT and PE; any time: drugs, transfusion
- Severe wound infection within 48 h: think necrotising infection
Anastomotic leak
- Tachycardia (often first), fever, ileus, abdominal pain, confusion
- CRP still over about 150 mg/L on day 3–4 is a warning
- CT with contrast; return to theatre if peritonitis
Oliguria
- Under 0.5 mL/kg/h: check the catheter first
- Assess fluid status; fluid challenge if dry
- Review NSAIDs, ACE inhibitors, nephrotoxins; check U&E and potassium
Bleeding
- Primary: during surgery
- Reactive: within 24 h (slipped ligature, rising blood pressure)
- Secondary: 7–10 days, from infection
Others
- Ileus: correct potassium and magnesium, reduce opioids, mobilise
- Wound dehiscence (salmon-pink fluid, days 7–10): cover with saline gauze, theatre
- VTE prophylaxis by risk; 28 days of LMWH after major abdominal or pelvic cancer surgery
- Delirium: screen with the 4AT; look for infection, drugs, retention, hypoxia, pain
Clavien-Dindo
- I: any deviation, no specific treatment
- II: drugs, transfusion, TPN
- III: surgical, endoscopic or radiological intervention
- IV: life-threatening, ICU
- V: death
Exam pearls
- Tachycardia on day 5 after bowel surgery is a leak until proven otherwise
- A D-dimer is unhelpful after surgery
- Restrictive transfusion: Hb 70 g/L in most patients