Are postoperative complications (POC) common, often predictable, and sometimes mitigable?

From the Guidelines

True. Postoperative complications (POC) are indeed common, often predictable, and sometimes can be mitigated. These complications occur in a significant percentage of surgical patients and include issues such as surgical site infections, venous thromboembolism, respiratory complications, and cardiovascular events. They are often predictable because certain patient factors (advanced age, obesity, diabetes, smoking history) and procedure characteristics (complexity, duration, emergency status) are known to increase risk, as supported by a study that found preoperative American Society of Anesthesiologists (ASA) score and Portsmouth-Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM) were significantly predictive of length of stay (LOS) and cumulative morbidity 1. Many complications can be mitigated through preventive strategies like preoperative optimization of medical conditions, appropriate antibiotic prophylaxis, early mobilization, adequate pain control, and thromboprophylaxis. Healthcare providers use risk assessment tools, such as track and trigger physiological scoring systems, to identify high-risk patients and implement targeted interventions, with studies showing that early warning scores (EWS) can predict development of a complication and its severity up to 3 days prior to diagnosis of the complication 1. Despite best efforts, some complications remain unavoidable, but early recognition and prompt management can minimize their severity and impact on patient outcomes, with the failure to rescue (FTR) rate being modifiable by institutional factors such as higher nurse to patient ratios 1. Key to improving outcomes is the implementation of protocols to monitor, detect, and act on complications, including the use of rapid response teams which include an intensivist experienced in management of postoperative surgical patients 1. Overall, the ability to predict and mitigate postoperative complications is crucial in reducing morbidity, mortality, and improving quality of life for surgical patients.

Some of the key points to consider in mitigating postoperative complications include:

• The use of risk assessment tools to identify high-risk patients
• Implementation of preventive strategies such as preoperative optimization of medical conditions and appropriate antibiotic prophylaxis
• Early mobilization, adequate pain control, and thromboprophylaxis
• The use of track and trigger physiological scoring systems to predict development of complications
• Prompt management of complications to minimize their severity and impact on patient outcomes
• The implementation of protocols to monitor, detect, and act on complications, including the use of rapid response teams.

It is essential to note that the failure to rescue (FTR) rate is higher in frail older populations 1, and that the risk of a specific pattern of secondary complications appears related to key index complications, such as deep space surgical site infection being related to wound dehiscence 1. Therefore, healthcare providers should be aware of these factors and take a proactive approach to mitigating postoperative complications and improving patient outcomes.

From the Research

Postoperative Complications

• Postoperative complications are common, with studies indicating that they occur in a significant percentage of cases, ranging from 20% to 31.50% of patients 2, 3, 4.
• These complications can be predictable, with certain risk factors contributing to their development, such as patient-specific and surgery-specific factors, including comorbidities, higher ASA grade, higher BMI, emergency surgery, and open surgery 2, 3.
• Mitigation of postoperative complications is possible through various measures, including:
  • Identifying and addressing modifiable risk factors 2
  • Implementing a multidisciplinary approach to patient care 2, 5
  • Promoting early mobilization and pulmonary care 5
  • Providing patient and family education 5
  • Implementing infection control practices 3
• Examples of postoperative complications that can be mitigated include:
  • Pulmonary complications, such as pneumonia and unplanned intubation, which can be reduced through programs like I COUGH 5
  • Acute kidney injury, gastrointestinal complications, postoperative anemia, fever, and delirium, which can be managed through guidelines and protocols 2
• The answer to the question is: True
• Postoperative complications can have significant implications for patient-centered outcomes, including increased mortality, length of stay, and need for an increased level of care at discharge 6.