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Early Postoperative Complications

Robert James Cerfolio
Early Postoperative Complications is a topic covered in the Pearson's General Thoracic.

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Key Points

  • Careful patient selection, intraoperative techniques, and aggressive postoperative care are essential to minimizing postoperative complications.
  • Despite careful selection, air leaks and pulmonary complications are common.

The postoperative care of a patient who is to undergo pulmonary resection starts long before the incision is made. Smoking cessation, pulmonary rehabilitation, incentive spirometry teaching, and patient education are all critical factors that help minimize some of the more common early postoperative complications described in this chapter. Additionally, careful patient selection based on pulmonary function tests, comorbidities, cardiopulmonary reserve, and the patient’s motivation to recover are also important factors. These preoperative factors must be followed by a meticulous operation that is efficient but not hurried and has minimal blood loss. The postoperative team is comprised of experienced and vigilant nurses, pain specialists, respiratory therapists, and physical therapists. Ideally, this team works on a hospital unit that allows continuous telemetry to monitor cardiac rhythm and pulse oximetry to monitor oxygen saturation of postoperative patients. However, despite maximization of all of these factors and adherence to the motto, “The best treatment of postoperative complications is prevention,” early complications occur nonetheless.

The mortality rate from elective pulmonary resection is on the decline according to recent reports.[1] However, in some large studies, it is two to four times greater than that of elective coronary artery bypass surgery.[2],[3]The incidence of major morbidity in several large series is also high, ranging from 10% to 70%, with most series reporting approximately 30% to 40%.[4],[5]

As the population continues to age, as more patients receive neoadjuvant chemotherapy and/or radiotherapy, and as more patients are immunocompromised, complications will continue to occur and are a humbling part of the practice of thoracic surgery. This chapter provides a brief overview and describes the incidence, risk factors, and management of the some of the common early postoperative complications occurring after pulmonary resection, beginning with the most common.

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Key Points

  • Careful patient selection, intraoperative techniques, and aggressive postoperative care are essential to minimizing postoperative complications.
  • Despite careful selection, air leaks and pulmonary complications are common.

The postoperative care of a patient who is to undergo pulmonary resection starts long before the incision is made. Smoking cessation, pulmonary rehabilitation, incentive spirometry teaching, and patient education are all critical factors that help minimize some of the more common early postoperative complications described in this chapter. Additionally, careful patient selection based on pulmonary function tests, comorbidities, cardiopulmonary reserve, and the patient’s motivation to recover are also important factors. These preoperative factors must be followed by a meticulous operation that is efficient but not hurried and has minimal blood loss. The postoperative team is comprised of experienced and vigilant nurses, pain specialists, respiratory therapists, and physical therapists. Ideally, this team works on a hospital unit that allows continuous telemetry to monitor cardiac rhythm and pulse oximetry to monitor oxygen saturation of postoperative patients. However, despite maximization of all of these factors and adherence to the motto, “The best treatment of postoperative complications is prevention,” early complications occur nonetheless.

The mortality rate from elective pulmonary resection is on the decline according to recent reports.[1] However, in some large studies, it is two to four times greater than that of elective coronary artery bypass surgery.[2],[3]The incidence of major morbidity in several large series is also high, ranging from 10% to 70%, with most series reporting approximately 30% to 40%.[4],[5]

As the population continues to age, as more patients receive neoadjuvant chemotherapy and/or radiotherapy, and as more patients are immunocompromised, complications will continue to occur and are a humbling part of the practice of thoracic surgery. This chapter provides a brief overview and describes the incidence, risk factors, and management of the some of the common early postoperative complications occurring after pulmonary resection, beginning with the most common.

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Last updated: December 4, 2019