Postoperative Complications
Postoperative complications are a common occurrence in colon and rectal surgery. Prevention of postoperative complications requires adequate preoperative assessment of risk along with meticulous intraoperative and postoperative care. Standardizing preoper
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Key Concepts • Thorough preoperative evaluation including assessment of social situation, cognitive status, and comorbidities contribute to safe postoperative recovery. • Laparoscopic approach to colorectal surgery is associated with a decreased risk for postoperative complications. • Risk for mortality after major postoperative complications is a reflection of surgeon as well as the system in which the surgeon operates. • Meticulous operative technique with particular attention to hemostasis will lead to improved postoperative outcomes. • Postoperative management with an enhanced recovery after surgery protocol leads to decreased postoperative complications. • Bowel preparation with oral antibiotics correlates with a decreased risk of superficial surgical site infection.
Introduction Postoperative complications are common in colorectal surgery with an incidence as high as 40 % depending upon the study. Many studies have been reported which characterize the complications and their frequency. The overarching goal of this chapter is to highlight some of this literature in an attempt to give the reader a broad overview of some of the issues surrounding postoperative complications.
Preoperative Considerations and Prediction of Postoperative Complications Given the frequency of postoperative complications and their implications on quality of life, much current work focuses on prevention of complications. To that end, many authors have
used the database that has come out of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) to characterize postoperative complications [1–6]. Perhaps one of the most significant developments is that of the ACS NSQIP surgical risk calculator [7, 8]. This tool uses procedure-specific information to provide an accurate prediction both of risk for various complications as well as hospital length of stay. Importantly, the ACS NSQIP calculator provides risk stratification that allows the patient to see their risk in the context of other more average-risk patients. Figure. 8-1a, b is an example of a report obtained from the ACS NSQIP risk calculator. These types of tools allow surgeons to not only anticipate various complications but to guide patient counseling on expected outcomes. This type of informed consent allows surgeons to consider the outcomes that are most important to patients so they can make decisions that align with their goals of life [9, 10]. While this risk calculator seems to accurately predict postoperative complications [8], risk prediction is dependent upon the accuracy of the data entered into the model. Furthermore, factors exist that impact the outcomes that cannot be measured by any specific model. For example, Dr. Senagore’s group investigated the accuracy of the ACS NSQIP risk calculator in predicting outcomes in a highvolume minimally invasive colorectal surgery practice [11]. The authors of this study found that the risk calculator generally overestimated the rate of complications [11]. The authors proposed that the discrepancy in
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