Review Of Postoperative Complications Essay Paper

Review Of Postoperative Complications Essay Paper

APA style

6-8 page paper (page count includes title and reference pages) which includes:

Introduction with a clearly written thesis statement

Background section introducing the history and current views on the concept/matter

A section on the fallacies, myths, emotions, or biases, evident when this concept/matter is discussed

Provide a real-life case-study wherein the concept/matter and its surrounding premises impacted patient care or outcomes

A section on evidence-based approaches to the concept/matter

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Conclusion

A minimum of 4 references

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Complications in Post-Operative Client

            The postoperative period is considered to be the longest compared to all other perioperative periods. This period is made up of three phases; phase 1 begins after the surgery and nurses are able to identify the potential problems, hence, intervene to minimize morbidity, risk, and mortality. This phase may last for a considerable period, though it depends on the health status of the patient and the nature of the surgery performed. Phase 2 involves the preparation of the client for an extended-care environment, such as a skilled nursing facility (SNF), an acute care unit, or a home. Normally, this phase may last for 1-2 hours. Phase 3 of the post-operative period focuses on the provision of care in an extended-care environment, at the client’s home or within the hospital. An SNF is assigned to clients who cannot manage their postoperative care at home. However, clients are at risk of experiencing complications, which significantly affect the quality of life and the recovery process after undergoing surgery. Thus, this paper focuses on reviewing the complications experienced by these patients.

Background

            Complications in the postoperative period after surgery cause long hospital stays, suffering and death, and increase costs. Hobson, Hadjipavlou & Stephens (2016) argue postoperative patients are likely to die five years after undergoing surgery. The authors add that between 20,000 and 25,000 deaths in UK hospitals occur due to the complications that patients face after their surgeries. Patients with postoperative complications are considered to be at high risk of morbidity and mortality. Nevertheless, quantification of the true rates of complications in postoperative clients has been difficult because there is a lack of universally agreed definitions, which makes it impossible to make comparisons between various countries and hospitals.

Currently, the true causes of postoperative complications are yet to be identified; however, some risk factors have been highlighted to help in developing scoring systems to help with pre-operative risk stratification. Some researcher perceives several patients have their immune systems in a susceptible state before undergoing surgery, which causes them to experience postoperative complications.

Fallacies, Myths, Emotions, or Biases on Post-Operative Complications

There are potential myths, fallacies, emotions, or biases surrounding postoperative complications. Antonacci et al. (2021) show how cognitive bias has a significant impact on managing complications in postoperative patients. The authors write cognitive bias (CB) to be a notable source of management error in surgical cases. Antonacci et al. (2021) conducted a study, which involved 736 surgical cases with postoperative complications from three hospitals. Cognitive bias was associated with 241/736 of all cases with postoperative complications. The cognitive biases established were confirmation, anchoring, commission, omission, premature closure, overconfidence, diagnosis momentum, outcome, hindsight, and ascertainment bias. Thus, this study identified cognitive biases to be responsible for increasing management errors in surgical cases that accrue to postoperative complications.

Surgery has a significant impact on life. Regardless of the size and nature of the surgery, the experience can lead to significant side effects. Surgeons do notable tasks in providing their patients with knowledge of the physical side effects of both the pre-operative and post-operative procedures; however, rarely do they educate their clients on the emotional side effects (El Hechi et al., 2020). Thus, post-operative clients experience emotions that are rarely discussed. Notably, clients face post-operative depression, which is distinctive from depression; though is a “situational form of depression that can last up to one year from the day of surgery” (El Hechi et al., 2020). this feeling lasts for a while, and when untreated it goes on for months. Unfortunately, even in successful surgery, post-operative clients can experience feelings of hopelessness toward their full recovery. Therefore, the available information shows that post-operative patients face emotions, and the period is impacted by biases.

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 Real-Life Case-Study of Post-Operative Complications

            A 74-old-years man underwent surgery due to identified blockage in his left femoral artery.  The history of the patient shows to have a significant vascular compromise of his left leg secondary to the identified blockage. A stent was placed when the patient was undergoing his surgery and transferred to the Post Anesthesia Care Unit (PACU). Upon arriving in the PACU, the patient’s vital signs recorded were; pulse 80 beats per minute, blood pressure 162/86 mm Hg, core temperature 34.5°C, respiratory rate 16 breaths per minute, and oxygen saturation 90%. Extubation was performed on the patient before arrival in the PACU. When the patient stabilized and the assessment was completed, a warm air convection device was used to make him warm. To address the patient’s low oxygen saturation, the oxygen flow was improved to 6 liters per nasal cannula.

Fifteen minutes after the patient’s arrival in the PACU, he begins to complain of severe pain originating from his left leg. When assessed, his peripheral pulses were good and pink in color.   Nevertheless, this was a surgical site, and the nurse attending to him called the surgeon. After speculations, the surgeon says the pain is secondary to sequestered by-products removal of circulation, and new perfusion in the leg. The surgeon ordered the patient medication for pain – 3 mg hydromorphone, which assists to resolve the complaints of the patient.

It took one hour for the vital signs of the patient to return to similar to the preoperative values; his temperature was 36°C. However, the patient continues to complain of pain in his lower extremities. After the assessment, it was established that the patient’s peripheral pulses were weak in his right leg, and the extremity had a cool touch and dusky color. The patient’s left leg remained with fortunate peripheral pulses, pink, and warm. A pillow was used to elevate the patient’s legs in order to enhance blood return to his heart and was given a dose of hydromorphone. This dose caused the patient to drift off to sleep. However, upon waking up he continued to complain of pain in the extremities. The right leg continues to be dusky, cool, and with bad peripheral perfusion. The surgeon is contacted again, who establishes that the patient is possibly experiencing the development of a Deep Vein Thrombosis (DVT) in the right calf. The patient’s right leg was applied with compression stockings in order to minimize the risk of clot formation. At this point, anticoagulants were not ordered because the patient had been heparinized in the operating room.

The patient was discharged to the surgical ward from the PACU. On the third day, when the patient is walking in the hall, he experiences a cardiac arrest that makes resuscitation to be impossible. There is a high contingency that he sustained a pulmonary embolus, which is secondary to the DVT in the patient’s right leg. The walking might have contributed to knocking off the clot, making it lose and resulting in its movement to the pulmonary vasculature.

Based on the length and type of surgery, as well as the medical history, the patient was most likely to experience DVT formation. Also, after being anticoagulated in the operating room, no other intervention was administered. The institution of intermittent pneumatic compression devices or graduated compression stockings was the only best option in addition to anticoagulation.

Evidence-Based Approaches to Postoperative Complications

Postoperative vomiting and nausea, and acute pain remain to be the major complications in perioperative management. The EBP (Evidence-Based Practices) has received considerable attention in the care and treatment of postoperative complications and has significantly impacted the quality of clinical care of nurses. Therefore, to achieve effectiveness in addressing postoperative care, a balance needs to be maintained between the use of resources required by the patients who need more care and those who need minimum care. Various tools have been developed to improve postoperative patient care following their clinical status. This indicates that postoperative complications are general and specific based on the surgery performed; hence, the approach used to address these complications should be in alignment with the clinical characteristics of a particular patient (Calvache et al., 2015). Moreover, based on the most significant postoperative complications

(acute pain, nausea, and vomiting), this paper covers two evidence-based approaches.

Roofthooft et al. (2021) say the European Society of Regional Anaesthesia and Pain Therapy established the Procedure Specific Postoperative Pain Management (PROSPECT) initiative in order to develop treatment strategies to help in pain management in patients with postoperative complications. Adaptation of this initiative has been helpful to various healthcare settings, to address the problems that continue to prevail in operating rooms, considering how acute postoperative pain is inadequately treated. This initiative directs healthcare providers on how to tackle postoperative pain. Guidelines contained in this initiative make the approach to postoperative management to be effective, and improve patient care policies.

In the management of postoperative nausea and vomiting (PONV), the perioperative situation is highly considered as well as the risk factors, such as female gender, kinetosis, non-smoker, and postoperative opioids. Thus, this pharmacological approach may be adapted by clinical practitioners to help deal with significant postoperative complications as identified in this review. Transdermal scopolamine and metoclopramide are commonly used in the management of PONV. Research shows that these medications are effective in addressing this postoperative complication (Ames & Machovec, 2020).

Conclusion

            Postoperative complications continue to prevail despite the efforts that have been put in place to manage the complications. The complications have a significant impact that leads to increased morbidity and mortality. However, different tools are being developed in a bid to eliminate the potential causal factors of postoperative complications. Also, approaches are improved to tackle these problems to enhance the delivery of quality healthcare services and improve quality of life as well as ease the journey to full recovery after surgery.

References

Ames, W. A., & Machovec, K. (2020). An Update on the Management of PONV in a Pediatric                  Patient. Best practice & research clinical anaesthesiology, 34(4), 749-758.

Antonacci, A. C., Dechario, S. P., Antonacci, C., Husk, G., Patel, V., Nicastro, J., … & Jarrett, M. (2021). Cognitive bias impact on management of postoperative complications, medical                  error, and standard of care. Journal of Surgical Research, 258, 47-53.

Calvache, J. A., Guzmán, É. L., Buitrago, L. M. G., Torres, C. G., Torres, M., Buitrago, G., &                  Duarte, H. G. (2015). Evidence-based clinical practice manual: Postoperative complications         management. Colombian Journal of Anesthesiology, 43(1), 51-60.

El Hechi, M. W., Bohnen, J. D., Westfal, M., Han, K., Cauley, C., Wright, C., … & Kaafarani, H. M.        (2020). Design and impact of a novel surgery-specific second victim peer support              program. Journal of the American College of Surgeons, 230(6), 926-933.

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Hobson, B., Hadjipavlou, N., & Stephens, R. C. (2016). An Introduction to Postoperative              Complications. University College London. https://www. ucl. ac.                                                     uk/anaesthesia/StudentsandTrainees/Intro_to_postop_Complications. Accessed Nov.

Roofthooft, E., Joshi, G. P., Rawal, N., Van de Velde, M., PROSPECT Working Group* of the                  European Society of Regional Anaesthesia and Pain Therapy and supported by the Obstetric         Anaesthetists’ Association, Joshi, G. P., … & Freys, S. (2021). PROSPECT guideline for   elective caesarean section: updated systematic review and procedure‐specific postoperative     pain management recommendations. Anaesthesia, 76(5), 665-680. Review Of Postoperative Complications Essay Paper