Assessment of late postoperative complication in the emergency department

Abstract

Nowadays, due to the shortening of the hospital stay, it is quite common for surgical patients to develop surgical complications which will declare themselves after having been discharged. Usually, the first point of contact to receive medical treatment will be the Emergency Department. Post-operative complications can be divided into early-onset, the ones which occur in the first 4 weeks, and late-onset for the ones developing more than 4 weeks after surgery. Early-onset complications are the most common, and usually they tend to appear in the immediate postoperative period. These include seromas, surgical wound infections, eviscerations, ileus, anastomotic leak, and medical complications such as pneumonia and thromboembolism. Later-onset complications are more specific to the type of procedure performed. Classic examples are jaundice due to stricture of the bile duct stenosis after hepatobiliary surgery or afferent loop syndrome secondary to gastric surgery. An early diagnosis of any complications reduce their negative impact and helps in their treatment. For these reasons, the Emergency physician must have a high index of diagnostic suspicion. Computed Tomography (CT) scan with intravenous contrast is almost always the best modality to reach a diagnosis. An early surgical consultation is always advisable.