Principles of Postoperative Care
- Monitoring must be appropriate to the patient and the procedure.
- Maintenance of homeostasis includes temperature, fluid balance, and oxygen saturation.
- Pain control is important.
- Early return of nutrition and mobility are postoperative goals.
- Prevention of specific complications includes respiratory and cardiovascular complications, as well as venous thromboembolism.
- Standardized care pathways preoperatively, intraoperatively, and postoperatively yield superior outcomes
Excellent surgical, anesthetic, physiotherapeutic, and nursing care are all required for optimal postoperative results after any thoracic surgical procedure. Each of these teams involved in patient care is important to reach the general goals of the postoperative period:
1. Recovery from both the specific physiologic changes and the general inflammatory response due to the surgical procedure
2. Decreased pain, early mobilization, and prompt return to normal function
3. Prevention and early detection of complications
Physicians involved in the patient’s preoperative care and assessment must carefully assess the risks and benefits of surgery. The balance of risks and benefits plays an important role in the selection of appropriate candidates for surgical resection. Preoperative assessment is covered elsewhere but it is important to state here that excellent postoperative care begins with seasoned judgment regarding risk assessment. Overall perioperative mortality of thoracic surgical procedures ranges from less than 1% for low-risk lobectomy to 10% for high-risk esophagectomy. This mortality is mainly caused by major respiratory complications, such as atelectasis, pneumonia, and respiratory failure, which can occur in up to 15% of these patients. Cardiac complications occur in less than 10%. Specific respiratory evaluation of both mechanics and gas exchange, as well as other special considerations, must be performed in addition to standard preoperative assessments. This chapter discusses the general postoperative care of patients undergoing major thoracic procedures. Additional considerations regarding specific operations may be found in their respective chapters.
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