Inpatient Surgical Service Update Management
Patient 1: Post-Operative Incisional Hernia Repair (POD-3)
Continue current management with close monitoring for seroma formation and wound infection, which are the most common complications following laparoscopic incisional hernia repair. 1
- Pain management: Decreasing surgical site pain on POD-3 is expected and appropriate; continue current analgesic regimen 1
- Vital signs: All parameters are within normal limits (HR 68, BP 110/62, RR 20, SpO2 99% RA) indicating stable postoperative course 1
- Complication surveillance: Monitor specifically for seroma formation (occurs in 5.45% of laparoscopic repairs) and postoperative pain (2.75%), which are the two most common complications 1
- Wound infection risk: This patient has a significantly elevated infection risk (16% for incisional hernia repairs vs 1.5% for other clean procedures), requiring vigilant wound assessment 2
- Discharge planning: Laparoscopic approach typically allows faster recovery and shorter hospital stay; consider discharge if tolerating diet, ambulating, and pain controlled 1
Patient 2: Mesh Removal with Deep SSI (POD-2)
Maintain current drainage management and continue close monitoring for recurrent infection, as this patient has a 41% risk of reinfection given the history of previous wound infection. 2
- Drain output: 30ml serosanguinous drainage is appropriate for POD-2; continue monitoring volume and character 2
- Infection surveillance: Previous wound infection increases reinfection risk to 41% (vs 12% without prior infection), necessitating heightened vigilance 2
- Vital signs: Stable parameters (HR 76, BP 121/80, RR 18, SpO2 98% RA) with no fever spikes indicate adequate source control 2
- Pain management: Decreasing pain is reassuring; continue current regimen 2
- Antibiotic consideration: Given the deep SSI requiring mesh removal, ensure appropriate antibiotic coverage is maintained based on culture results 2
Patient 3: Diabetic Foot Ulcer Post-Ray Amputation
Optimize glycemic control aggressively and maintain strict wound care protocols, as diabetes significantly increases postoperative complication risk. 3, 4
- Diabetes management: Type 2 diabetes is a significant risk factor for postoperative complications (p=0.005); ensure tight glycemic control with target glucose levels appropriate for surgical patients 3, 4
- Vital signs: Slightly elevated BP (132/84) requires monitoring; hypertension control is essential in diabetic patients 3
- Pain management: Wound site pain is expected; assess for neuropathic component given diabetic history 3
- Wound surveillance: Diabetic patients have higher infection risk; perform daily wound assessments for signs of infection, dehiscence, or poor healing 3
- Discharge planning: Ensure patient has appropriate diabetic foot care education and follow-up arranged 3
Patient 4: Pre-Operative Thyroidectomy (ASA II)
Proceed with planned total thyroidectomy and central neck dissection as patient is medically optimized with controlled hypertension. 5
- ASA classification: De novo hypertension alone does not elevate this patient beyond ASA II if well-controlled; age 65 alone is not a criterion for higher ASA classification 5
- PAC clearance: Patient is fit for surgery with stable vital signs (PR 84, BP 114/78, RR 20, SpO2 98% RA) 5
- Hypertension management: Ensure blood pressure remains controlled perioperatively; continue home antihypertensive medications up to surgery 5
- Surgical planning: Proceed with planned procedure; no additional preoperative optimization required 5
Patient 5: Traumatic Hydrocele with Epididymo-orchitis
Continue current management with close monitoring of neurological status given history of CVA, and ensure seizure prophylaxis is maintained. 4
- Pain improvement: Reduced hemiscrotum pain indicates appropriate treatment response; continue current analgesic regimen 4
- Vital signs: Stable parameters (PR 79, BP 118/66, RR 18, SpO2 98% RA) with no fever spikes suggest resolving infection 4
- Comorbidity management: History of CVA and epilepsy requires careful monitoring; these conditions increase perioperative delirium risk 4
- Hypertension control: Ensure antihypertensive medications are continued to prevent complications 4
- Seizure prophylaxis: Maintain anti-epileptic medications at therapeutic levels throughout hospitalization 4
Patient 6: Pre-Operative Breast Fibroadenoma Excision (ASA I)
Proceed with planned excision under sedation as patient meets ASA I criteria and is medically optimized. 5
- ASA classification: Healthy 20-year-old female with no systemic disease qualifies as ASA I 5
- PAC clearance: Patient is fit for procedure with normal vital signs (HR 76, BP 121/80, RR 18, SpO2 98% RA) 5
- Sedation appropriateness: ASA I patients are appropriate candidates for sedation administered by non-anesthesiologists 5
- Surgical planning: Proceed with planned excision; no additional preoperative testing required for ASA I patient 5
Patient 7: Pre-Operative Pilonidal Sinus Excision (ASA II)
Optimize blood pressure control before proceeding with planned excision, as current reading of 140/84 mmHg requires assessment. 5
- ASA classification: Elevated blood pressure (140/84) may indicate uncontrolled hypertension, which could elevate classification from ASA I to ASA II if this represents mild systemic disease 5
- Blood pressure management: Verify if this is an isolated reading or represents uncontrolled hypertension; if persistent, optimize control before elective surgery 5
- Vital signs: Tachycardia (PR 94) and tachypnea (RR 22) may indicate anxiety or pain; assess and address before surgery 5
- Surgical planning: Once blood pressure is optimized and stable, proceed with planned excision with Limberg flap under spinal anesthesia 5
- Spinal anesthesia consideration: Appropriate choice for this procedure; ensure adequate preoperative hydration 5