Post-Operative Care Recommendations
The most effective post-operative care should follow Enhanced Recovery After Surgery (ERAS) principles, including multimodal pain management, early mobilization, and appropriate thromboprophylaxis to reduce morbidity, mortality, and improve quality of life.
Pain Management
- Implement multimodal analgesia including scheduled acetaminophen and NSAIDs as first-line agents if no contraindications exist 1
- Each patient should be assessed for the optimal perioperative analgesic regimen, considering sepsis presence and coagulation abnormalities 1
- Consider wound catheters and/or local abdominal wall blocks to reduce postoperative opioid demand, though efficacy may vary 1
- Thoracic epidural analgesia should only be used after assessment for sepsis and abnormal coagulation 1
- Intravenous NSAIDs like ibuprofen or naproxen can be effective for post-operative pain management 2
Early Mobilization
- Early mobilization is strongly recommended, with at least 30 minutes on the day of surgery and 6 hours per day thereafter 3
- Respiratory physiotherapy involving sputum clearance training, inspiratory muscle strength development, and deep breathing exercises should be used in the postoperative period 1
- Early mobilization helps prevent venous thromboembolism and promotes faster recovery 3, 4
Nutrition and Fluid Management
- A regular diet within 2 hours after surgery is recommended for appropriate procedures 1
- Avoid fluid overloading as it can worsen intestinal edema and prolong ileus 4
- Early oral intake should be encouraged with small portions initially, especially after right-sided resections and small-bowel anastomosis 4
- Blood glucose should be monitored and controlled in the range of 7.7–10 mmol/l preferably with variable rate insulin infusion 1
Thromboembolism Prevention
- Patients should be assessed with a validated tool for VTE risk on admission and throughout their hospital stay 1
- For high-risk patients (many emergency laparotomy patients), combine pharmacological with mechanical prophylaxis 1
- If pharmacological prophylaxis is not possible, mechanical prophylaxis should be administered 1
- Daily reassessment of thromboprophylaxis needs should occur postoperatively 1
Respiratory Care
- Patients who have undergone surgery and show evidence of hypoxemia should receive continuous positive airway pressure or noninvasive positive pressure ventilation if aspiration risk is low 1
- A multidisciplinary discussion at the end of surgery should assess suitability for endotracheal extubation as the risk of postoperative pulmonary complications is high 1
- Prevention of hypothermia using forced-air warming blankets, raising ambient room temperature, and warming irrigation and intravenous fluids is recommended 1
Wound Care
- Keep incision sites clean and dry for the first 48 hours 3
- Monitor for signs of infection including increased redness, swelling, warmth, pain, or drainage from incision sites 3
- If hair removal is needed before surgery, clipping rather than shaving is recommended 1
- Shaving should not be part of routine clinical practice 1
Special Considerations for Elderly Patients
- Patients over 65 years of age should receive regular postoperative delirium screening 1
- At-risk patients should be managed with non-pharmaceutical interventions such as regular orientation, sleep hygiene approaches, and cognitive stimulation to prevent delirium 1
- Medication triggers for delirium should be minimized 1
Urinary Catheter Management
- Urinary catheters should be removed immediately after surgery if possible 1, 3
- Early removal of urinary catheters can facilitate mobilization and prevent complications 4
- Suprapubic catheterization is superior to transurethral catheterization if used for >4 days 1
Monitoring and Follow-up
- Health systems should establish protocols for determining appropriate location for postoperative care based on validated preoperative risk scores 1
- Monitor vital signs, including respiratory rate, heart rate, blood pressure, oxygen saturation, level of consciousness, and surgical site for the first 24-48 hours 3
- Watch for signs of surgical site infection and other complications 1, 3