Late postoperative complications in surgical patients: an integrative review.

Álvaro Francisco Lopes De Sousa,Paula Regina De Souza Hermann,Denise De Andrade,Lucas Lazarini Bim,Inês Fronteira

doi:10.1590/0034-7167-2019-0290

Abstract

to identify the main complications in the late postoperative period of surgical patients. an integrative review from the CINAHL, LILACS, Science direct, Web of Science, SCOPUS, Europe PMC, and MEDLINE databases. Descriptors and keywords were combined without language or time restriction. ten primary studies were included. Infectious complications were the most common, especially surgical site infection, pneumonia and urinary tract infection. The presence of complications was linked to increased mortality, need for reoperations and worse survival. Few studies report on monitoring frequency, follow-up time and/or when complications started to be observed. infectious complications were the most prevalent postoperatively. The scarcity of guidelines that guide the monitoring of complications regarding monitoring frequency, follow-up time and classification makes it difficult to establish an overview of them and consequently propose intervention strategies.

Highlights

METHODSClinical complications after hospital discharge indicates a significant change in the surgical patient’s recovery, increasing the risk of reoperation, length of stay, decreased bed arrangement and increased mortality[1].There is no consensus on the actual incidence of postoperative complications, rates are estimated at 5.8% to 43.5% in the first 30 days[2,3,4,5,6,7], with overall mortality ranging from 0.79% to 5.7%(2,4-5,8) related to the type of surgery and severity of the complication
We excluded studies conducted with nonsurgical patients, which were developed with individuals under 18 years old or exclusively over 85 years old and who addressed only individuals in the immediate postoperative, intraoperative or preoperative period
The presence of complications was linked to increased mortality, need for reoperations and poor survival (Chart 2)

Summary

METHODS

Clinical complications after hospital discharge indicates a significant change in the surgical patient’s recovery, increasing the risk of reoperation, length of stay, decreased bed arrangement and increased mortality[1]. A recent study[13], based on a database of the Brazilian national health system, points out that the surgical volume in the country was 4,433 procedures/100,000 people in 2014. In this sense, it is very important to develop strategies for analysis, management and monitoring of patients undergoing these surgeries, especially to identify complications. It is very important to develop strategies for analysis, management and monitoring of patients undergoing these surgeries, especially to identify complications In this sense, the most important limitation in reporting postoperative complications is the lack of a standardized system to classify and characterize complications. It is necessary to better characterize these complications that include the specificities and aspects of monitoring, such as manifestation time, intensity, monitoring frequency, among others

OBJECTIVE

RESULTS

DISCUSSION

Study limitations

CONCLUSION