What are the post-operative care protocols, including average hospital length of stay, post-operative orders, and follow-up, for patients undergoing vascular surgery from a vascular surgery perspective?

From the Guidelines

Post-operative care after vascular surgery typically involves close monitoring in a hospital setting for 1-5 days, depending on the specific procedure performed, with an average length of stay of 2-3 days for endovascular procedures and 4-7 days for open surgeries, as supported by recent studies 1.

Key Components of Post-Operative Care

• Vital sign monitoring every 4 hours
• Assessment of the surgical site for bleeding or infection
• Neurovascular checks of affected extremities
• Pain management with medications like hydrocodone/acetaminophen 5/325mg every 6 hours as needed or tramadol 50mg every 6 hours
• DVT prophylaxis with subcutaneous heparin 5000 units three times daily or enoxaparin 40mg daily
• Early ambulation within 24 hours when possible

Medications and Anticoagulation

• Antiplatelet therapy with aspirin 81mg daily
• Additional anticoagulation depending on the procedure

Follow-Up Care

• Initial appointment 2 weeks after discharge to assess wound healing and remove sutures if necessary
• Visits at 1,3,6, and 12 months with vascular ultrasound surveillance to monitor for restenosis or graft patency
• Gradual increase in activity while avoiding heavy lifting (>10 pounds) for 4-6 weeks
• Maintenance of good hydration and recognition of signs of complications (fever, increasing pain, redness, swelling, or drainage)
• Adherence to medication regimens The implementation of enhanced recovery after surgery (ERAS) guidelines, as studied in 1 and 1, can lead to improved outcomes, including reduced hospital length of stay and complications. However, the specific application of these guidelines in vascular surgery must be tailored to the individual patient's needs and the type of procedure performed, considering factors such as the patient's overall health, the complexity of the surgery, and the potential for postoperative complications, as discussed in 1, 1, 1, 1, and 1.

From the Research

Post-Operative Care in Vascular Surgery

• The average length of stay in the hospital for vascular surgery patients can vary depending on the type of surgery and the patient's overall health, but studies have shown that high-risk patients are more likely to experience unplanned admissions to the intensive care unit postoperatively 2.
• Post-operative orders for vascular surgery patients may include pharmacological prophylaxis to prevent postoperative graft occlusion, such as low-dose acetysalicylic acid (ASA) or oral anticoagulation 3.
• The follow-up care for vascular surgery patients typically involves monitoring for postoperative complications, such as graft occlusion, wound infection, or lymphatic fistulas, and managing these complications promptly if they occur 4.

Post-Operative Complications

• Common postoperative complications in vascular surgery include systemic complications, local non-vascular complications, and vascular complications 4.
• Systemic complications are primarily caused by the patient's comorbidity, such as coronary heart disease or cerebral sclerosis 4.
• Local non-vascular complications include failure of wound healing, infection of the wound, and lymphatic fistulas, which can be reduced by using asepsis, atraumatic operative techniques, and perioperative antimicrobial prophylaxis 4.
• Vascular complications, such as failing grafts or infection of the bypass, can be managed by removing the infected synthetic graft or performing in-situ or extra-anatomical reconstructions 4.

Management of Postoperative Complications

• The management of postoperative complications in vascular surgery requires a multidisciplinary approach, including care team members through all phases of the surgical encounter 5.
• Identifying patient-specific and surgery-specific risk factors and addressing modifiable risks can mitigate the likelihood of developing postoperative complications 5.
• Common postoperative complications, such as acute kidney injury, gastrointestinal complications, postoperative anemia, fever, and delirium, can contribute to longer lengths of stay and rising health care costs, and require prompt management to prevent these outcomes 5.