Introduction:
Though the time during the surgery creates havoc for patients and caretakers, most of the mis-happenings can occur after the surgery, called postoperative complications. These complications occur as a result of poor surgical outcomes. The most common complication is delirium. Preventive measures are taken to decrease the incidence of delirium, such as carefully selecting drugs. Others, including pulmonary and cardiac complications, can also occur. Each of the complication and prevention strategies, along with treatments, are explained in this article.
What Are the Post-operative Complications in Elderly Patients During Surgery?
Following are the post-operative complications of elderly surgical patients
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Respiratory complications.
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Urinary retention.
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Ileus.
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Nutritional deficiencies.
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Wound complications.
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Cardiac complications.
1. Delirium:
Delirium after surgery usually occurs in nearly 15 percent of surgical patients and nearly 60 percent of older surgical patients. Delirium in the elderly population is usually present as quiet confusion, which is activated in the evening. It is also known as sundowning. Altering the consciousness level or a deficiency in the cognitive-ness, including change in a mental status during this phase, is also common.
Causes of Delirium:
Occur due to stress from the surgery or underlying medical issues, which include abnormal respiratory parameters, metabolic abnormalities, infections, and medications. Investigating these causes can live in better treatment outcomes.
Treatment of Delirium:
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Restoring the physical and mental function along with pharmacotherapy is the first line of treatment.
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Restoring functions such as sleep hygiene, respiration, hearing and vision, volume replenishment, and early mobilization were implemented to decrease the episodes of delirium.
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Nonmedical interventions include encouraging the social side of the patient by interacting with care given to us and others, and avoiding the use of mechanical restraints is also helpful.
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Psychoactive medications like antidepressants, NSAIDs, and anti-arithmetic drugs are advised.
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When the patient experiences symptoms of psychosis or depression, or personal distress, pharmacologic treatment of delirium is started. Haloperidol and Resperidol are the drugs of choice in treating delirium. High doses of these drugs can lead to complications; hence, they are cautiously administered once the symptoms of delirium resolve the dose of the medication is tapered gradually.
2. Pulmonary Complications:
The risk of postoperative pulmonary patients increases with increasing age and is higher in patients over the age of 60 years.
Predisposing Factors for Pulmonary Complications:
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Long-Acting Neuromuscular Blockers: As age increases, the compliance of the chest wall decreases, which further decreases respiratory muscle strength. Due to this, postoperative pulmonary complications and hypoventilation occur. For this reason, long-acting neuromuscular blockers should be avoided.
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Lung Expansion: Drowsiness, pain after surgery, and immobilization are certain factors that lead to shallow breathing, further leading to complications of the lungs. Increasing the lung capacity after surgery is essential, and it can be done with the help of deep breathing exercises, physiotherapy, and positive airway pressure. A particular lung expansion modality can be implemented.
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Surgery: The site of the surgery is a common risk factor for developing postoperative pulmonary complications. It is the surgical area close to the diaphragm, like upper abdominal surgery, that shows significant risk.
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Aspiration: Aspiration can occur as the oral protective reflexes decrease with increasing age. Patients with neurologic syndromes. Parkinson's disease or swallowing disorders are at higher risk. Careful administration of sedation should be done to prevent the patient from aspiration.
3. Cardiac Complications:
Cardiac diseases increase with increased age. Heart diseases, preoperative insulin, high-risk surgery, and altered creatinine levels can be risk factors for cardiac complications in the elderly after surgery. The use of statins, and beta blockers, controlling blood pressure can be used in preventing cardiac complications.
4. Ileus:
Ileus is a complication arising as a clinical consequence due to malnutrition, and prolonged duration of hospital stay. Ileus usually presents with the following symptoms such as:
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Nausea and vomiting.
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Abdominal distension.
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Flatus (presence of gas in bowel and abdomen).
Treatment of Ileus:
Intravenous nutrition and proper hydration should be done along with assisted ambulation and avoiding opioids. Symptomatic relief can be provided with the help of a nasogastric tube but not in treating ileus. Delay feeding orally until the bowel function is restored.
5. Urinary Retention:
Immobility, opioids, analgesics, and general anesthesia can lead to urine retention. Urine retention leads to infection of the urinary tract and also to altered function. Decreased excretion of urine and frequent voiding of less quantity of urine are the symptoms.
Treatment of Urinary Retention:
It can be treated with catheterization, which prevents bladder distension.
How Can Postoperative Complications in the Elderly Be Prevented?
Preventing post-operative complications can be done by following is appropriate intervention. Avoiding long-acting muscle relaxants and administering beta blockers and statins can be done based on the underlying cause of the complication.
Prevention of Delirium:
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Risk factors of delirium should be diagnosed and checked.
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The dose of the prophylactic drug Haloperidol should be lowered.
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Evaluation of dementia and alcohol abuse history should be done before surgery to identify high-risk patients.
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Abnormal laboratory values should be corrected.
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Meperidine, a drug for pain management, should be avoided.
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The level of sedation during the surgery should be checked.
Prevention of Pulmonary Complications:
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Incentive spirometry and other mechanical interventions can be used in patients with high risk to prevent the collapse of the lung.
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Avoid long-acting muscle relaxants.
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Vigilant care should be taken to avoid aspiration risks in an elderly patient.
Prevention of Cardiac Complications:
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Continuing beta-blockers and statins in patients during high-risk surgery can reduce cardiac complications.
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Hypertension should be controlled as it can be associated with myocardial infarction after the surgery.
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Active warming and temperature control are required in older patients as compared to younger patients.
Conclusion:
Postoperative complications usually occur in older people due to many reasons in which, the primary reason including age and underlying comorbidities. They include cardiac and neurologic complications along with wound complications. Prevention strategies can be implemented to combat the complications along with treating the complications as described in the area. Most of the complications occur after the surgery rather than during the surgery. Hence it is important to carefully monitor elderly patients for complications that can occur after the surgery.
