Late postoperative complications in surgical patients: an integrative review

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.

Results:

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.

Conclusion:

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.

Descriptors:
Operative Surgical Procedures; Complications; Postoperative Complications; Epidemiological Monitoring; Infections

Reason for exclusion	Quantitative excluded (n= 1847)
Duplicate studies	372
Does not address surgical patient	379
Performed exclusively with a patient aged 18 or younger.	15
Performed exclusively with a patient over 80 years old	08
Addresses pre and/or intraoperative patient complications	423
Addresses patient complications only in the immediate postoperative period	371
Does not address complications	175
Review studies	47
Opinion studies	53
Protocols	04

Article title	Year/Country	Outlining/Participants	Outcomes/Conclusions
The AFC Score: Validation of a 4-Item Predicting Score of Postoperative Mortality After Colorectal Resection for Cancer or Diverticulitis: Results of a Prospective Multicenter Study in 1049 Patient^s(¹⁹19 Alves A, Panis Y, Mantion G, Slim K, Kwiatkowski F, Vicaut E. The AFC Score: Validation of a 4-Item Predicting Score of Postoperative Mortality After Colorectal Resection for Cancer or Diverticulitis: Results of a Prospective Multicenter Study in 1049 Patients. Ann Surg [Internet]. 2007;246(1):91-6. doi: 10.1097/SLA. 0b013e3180602ff5 https://doi.org/10.1097/SLA. 0b013e31806... )	2007 France	A multicenter study to assess mortality and morbidity after colorectal surgery. N= 1,049 patients	The main complications were: dehiscence and wound infection (8%), postoperative hemorrhage (3%), and complications related to the cardiorespiratory tract (7%). Postoperative morbidity was observed in a significant portion (23%) of patients. Post-discharge reoperation due to complications was required in 42 patients (4%).
Complications after pancreaticoduodenectomy are associated with higher amounts of intra- and postoperative fluid therapy: A single center retrospective cohort stud^y(²⁰20 Kulemann B, Fritz M, Glatz T, Marjanovic G, Sick O, Hopt UT, et al. Complications after pancreaticoduodenectomy are associated with higher amounts of intra-and postoperative fluid therapy: a single center retrospective cohort study. Ann Med Surg. 2017;16:23-9. doi: 10.1016/j.amsu.2017.02.042 https://doi.org/10.1016/j.amsu.2017.02.0... ⁾	2017 Germany	A descriptive, documentary and retrospective study with patients submitted to duodenopancreatectomy. N: 553 patients	Infection, fistula, delayed gastric emptying and bleeding were the main complications. The incidence of complications was high (44.7%), with morbidity of 59.5%. Long-term mortality (30 days post-discharge) was 1.1%. Postoperative intervention was required to treat complications in 28.3% of patients, of which 12.1% reoperations.
Systematic Classification of Morbidity and Mortality After Thoracic Surgery⁽²¹21 Seely AJ, Ivanovic J, Threader J, Al-Hussaini A, Al-Shehab D, Ramsay T. Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg. 2010;90(3):936-42. doi: 10.1016/j.athoracsur.2010.05.014 https://doi.org/10.1016/j.athoracsur.201... ⁾	2010 Canada	A retrospective study assessing postoperative complications in thoracic surgery. N: 953 patients	Complication rates were 29.3%. The main ones were Surgical Wound Infection (30.8%), prolonged air escape (18.8%), atrial fibrillation (18.2%), and pneumonia (9.7%).
Morbidity after Total Gastrectomy: Analysis of 238 Patients⁽²²22 Selby LV, Vertosick EA, Sjoberg DD, Schattner MA, Janjigian YY, Brennan MF. Morbidity after total gastrectomy: analysis of 238 patients. J Am Coll Surg. 2015;220(5):863-71.e2. doi: 10.1016/j.jamcollsurg.2015.01.058 https://doi.org/10.1016/j.jamcollsurg.20... ⁾	2015 United States	A 90-day prospective follow-up cohort N: 238 students	The incidence of complications was 30%. The main ones were surgical wound infection (18.5%), esophageal anastomotic leak (14.7%), respiratory system complications (14.3%), cardiac arrhythmia (9.7%), organ-cavity infection (4.2%), and hemorrhage (3.4%). The readmission rate was high (20%). The presence of one or more complications increased the hospitalization time of the subjects.
Post-Discharge Complications are an Important Predictor of Post-operative Readmissions⁽²³23 Tevis SE, Kohlnhofer BM, Weber SM, Kennedy GD. Post-discharge complications are an important predictor of postoperative readmissions. Am J Surg. 2014;208(4):505-10. doi: 10.1016/j.amjsurg.2014.05.013 https://doi.org/10.1016/j.amjsurg.2014.0... ⁾	2014 United States	A retrospective study with patient undergoing general surgery. N: 3,556 patients	The incidence of complications was 31%, the most common being gastrointestinal complications (29.5%), surgical site infection (organ-cavity, superficial, deep and dehiscence) (26.3%), sepsis (3.8%), and urinary tract infection (2.9%). The average time between discharge and post-discharge complication was 10 days.
Value of General Surgical Risk Models for Predicting Postoperative Liver Failure and Mortality Following Liver Surgery⁽²⁴24 Haga Y, Ikejiri K, Takeuchi H, Ikenaga M, Wada Y. Value of general surgical risk models for predicting postoperative liver failure and mortality following liver surgery. J Surg Oncol. 2012;106(7):898-904. doi: 10.1002/jso.23160 https://doi.org/10.1002/jso.23160... ⁾	2012 Japan	A prospective follow-up study of postoperative course of hepatectomy. N: 960 patients	The incidence of post-discharge complications was 16.6%, the most common being: wound infection (2.5%), pleural effusion (2.9%), abscess (2.5%), pneumonia (1.2%), and hemorrhage (0.7%).
The Percutaneous Nephrolithotomy Global Study: Classification of Complications⁽²⁵25 Labate G, Modi P, Timoney A, Cormio L, Zhang X, Louie M, et al. The percutaneous nephrolithotomy global study: classification of complications. J Endourol. 2011;25(8):1275-80. doi: 10.1089/end.2011.0067 https://doi.org/10.1089/end.2011.0067... ⁾	2011 PubMed	A multicenter study with patients undergoing percutaneous nephrolithotomy. N: 5,724 patients	The incidence of complications was 20.5%. The main ones were fever (13.7%), hemorrhage (12.5%), urinary leakage (3.4%), and infections (4.6%).
The Impact of Postoperative Complications on Survivals After Esophagectomy for Esophageal Cancer⁽²⁶26 Booka E, Takeuchi H, Nishi T, Matsuda S, Kaburagi T, Fukuda K. The impact of postoperative complications on survivals after esophagectomy for esophageal cancer. Medicine. 2015;94(33):e1369. doi: 10.1097/MD. 0000000000001369 https://doi.org/10.1097/MD. 000000000000... ⁾	2015 Japan	A retrospective cohort with surgical esophagectomy graduates N: 402 patients	There was a high incidence of surgical complications (40.1%), the main ones being pneumonia (22.5%), surgical wound infection (11.3%), anastomosis (15.8%), and laryngeal nerve paralysis (19.4%).
Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study⁽²⁷27 Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ Open. 2005;331:1374. doi: 10.1136/bmj.38643.663843.55 https://doi.org/10.1136/bmj.38643.663843... ⁾	2005 England	A prospective observational cohort of older adults undergoing hip fracture surgery. N: 2,448 patients	498 patients had at least one postoperative complication (20%). The most common were chest infection (9%), heart failure (5%) and other infections (organ-cavity, UTI) (5%). Mortality was 9.6% at 30 days after hospitalization. In patients who developed postoperative chest infection, mortality at 30 days was 43%.
Association of Postoperative Complications with Hospital Costs and Length of Stay in a Tertiary Care Center⁽²⁸28 Khan NA, Quan H, Bugar JM, Lemaire JB, Brant R, Ghali WA. Association of postoperative complications with hospital costs and lengthof stay in a tertiary care center. J Gen Intern Med. 2006;21(2):177-80. doi: 10.1111/j.1525-1497.2006.00319.x https://doi.org/10.1111/j.1525-1497.2006... ⁾	2005 Canada	A retrospective descriptive study in patients undergoing noncardiac surgery. N: 7,457 patients	About 6.9% of patients had at least one post-discharge complication. Pneumonia (3%), hemorrhage (1.8%), sepsis (1.3%), and cardiac complications (1.3%) were prevalent.

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[1] Corresponding author: Álvaro Francisco Lopes de Sousa. E-mail: alvarosousa@usp.br