What are some post op complications I should be aware of?

Fever

Fever is a vague symptom that can be normal and even expected after surgery; up to 90% of surgical patients have a low grade fever due to the body’s inflammatory response to injury. However, it can also be a sign of something more serious, such as atelectasis (collapse of small air sacs in the lung), urinary tract infection (especially if you had a foley catheter placed for surgery), wound infection, or blood clots.

A slight fever in the first two days after surgery is most likely nothing to be concerned about. However, if you develop other symptoms or if your fever worsens or persists, contact your doctor. The best way to deal with post-op fever is by preventing the more serious causes, as described in the following.

Atelectasis (collapse of air sacs in the lung)

Atelectasis can stem from the effects of anesthesia as well as a decrease in physical activity and shallow breathing after surgery. It can lead to pneumonia and other more serious respiratory complications. Depending on your procedure, coughing and deep breathing exercises may cause discomfort, but they play an important role in your recovery. Splinting (holding a pillow firmly against your incision) and adequate pain control can help make deep breathing less painful, especially if your surgery involved your chest or upper body.

You may also be sent home with an incentive spirometer. This is a device you’ll use to help expand your lungs thoroughly and gives a give visual representation of your breathing. Not everyone will need an incentive spirometer but everyone should practice some form of deep breathing and coughing to prevent atelectasis during recovery.

Urinary Retention or UTI

Blood Clots

Blood clots can form in the larger veins, commonly in the arms or legs; they can also break loose and travel, making them potentially life threatening. However, proper surveillance and preventive techniques can help reduce the risk. We screen every patient with a deep vein thrombosis (DVT) risk assessment tool and certain patients are required to have a pre-op ultrasound of their legs to check for existing blood clots.

There are also a number of techniques surgeons can use to help reduce the risk of clot formation, including “blood thinners” – anti-thrombotic medications given to help keep blood from clotting; the use of compression or ted hose during and after surgery; and the use of sequential compression devices that massage the calves to keep the blood from pooling.

While recent data call into question these risk reducing techniques for DVTs, the easiest and cheapest form of prevention during recovery is early ambulation. Ambulation, or walking, has several benefits besides blood clot prevention; it also helps promote deep breathing and helps with gas, bloating, and constipation. We want our patients up and walking by the evening of their surgery day, but always follow your surgeon’s instructions for activity limitations.

Written by Jennifer “Coop” Cooper MS, APRN, AGACNP-BC, Sergeant, US Army (veteran)

Click here for the original blog post written by Jennifer Cooper MS, APRN for BuildMyHealth.

The post Preventing Post Op Complications first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

A few things I wish I knew before surgery

Post-op constipation is real.

The combination of narcotic pain medications, decreased activity, and poor dietary intake can lead to some serious constipation, so drink all the water, eat all the fiber, and walk, walk, walk. Unless you have other medical issues, you’ll need 2-3 liters of water (sorry, your coffee doesn’t count), and 20-30 grams of fiber every day. For reference, a serving of bran cereal has about 5.5 grams; fiber supplements like Metamucil can help you meet your goal and are actually pretty tasty these days.

As for walking, we like our patients up and walking the same evening of surgery (but always defer to your doctor’s instructions). Walking not only staves off constipation, it’ll also help prevent potentially fatal blood clots, so win-win.

What you eat, drink, and do can affect wound healing.

We already discussed the copious amounts of water and fiber you’ll be consuming, but there are other nutrients you’ll need to be aware of to help maximize your recovery. Low fat protein, zinc, calcium, and vitamins C & D are important factors in wound healing. And while it’s always better to get your nutrients from whole food sources, supplements may be beneficial to some people. Try a calorie tracking app on your phone to see how your nutritional intake stacks up.

On the flip side, there are a few things you should avoid, as they are known to delay or complicate wound healing. Nicotine is the biggest “NO” out there, but you should also monitor your intake of caffeine (like that coffee we talked about), alcohol, and excessive salt and sugar. A balanced diet of fresh fruits, veggies, and lean protein is almost always best.

What about lymphatic massage? We get asked this a lot. Lymphatic massage purportedly helps relieve pain and swelling, break up scar tissue, and improve blood flow to the area, thus promoting healing. There isn’t much data available to back up these claims, but some people swear by it (while others find it painful). We tell our patients they are welcome to try it if they’re interested, but we can’t promise any specific results from it.

Post-procedure depression can happen.

A lot goes into your emotional wellbeing after surgery, such as a personal history of depression/anxiety, reaction to medications, concerns about recovery, feelings of guilt for depending on others, or financial stress. For some people, these negative emotions can linger to become post-op depression. If you can’t shake the negativity or if you’re having excessive fatigue, changes in appetite or sleep, increased irritability, or any other symptom of depression, it’s important to get the help you need. Talk to your doctor if you have concerns about post-operative depression.

Good help will be invaluable and meal prep is a life saver.

In the days leading up to your surgery, go over your needs and expectations during recovery with your primary caregiver. Will you need dressings or other supplies? Get them now. Depending on the surgery, you might want to have gauze, medical tape (look for soft fabric or paper tape, not plastic), and maybe some “chux”/puppy pee pads  – those absorbent pads you can put down to catch drainage, etc. Have some gloves available if you need help with dressing changes. Check with your doctor to see what you might need. Don’t forget your personal hygiene needs during this time as well. You might want to pick up some dry shampoo, baby wipes, or body powder if full showers are limited. A bidet attachment on your toilet might be worth the investment – they’re under $50 and easy to install. Do you have periods? Stock up on your supplies and discuss any assistance you’ll need with your caregiver.

Also use this time to meal prep – whip up some big pans of lasagna or casserole to freeze for later. Stock up on easy to eat, nutritious foods like whole grain toast with peanut butter, soups, and produce. If you know you’re prone to nausea, crackers and ginger ale are good to have on hand. Fresh out of anesthesia, the B.R.A.T. (bananas, rice, applesauce, and toast) diet is nutritious and easy to digest.

One last consideration is maneuverability in your home. If you’re going to need assistance – whether it’s another person or it’s equipment like a walker or crutches – you’ll probably need to make space. Take some time to move trip hazards like area rugs or power cords and consider if you’ll need things like grab bars in your shower or near your toilet.

Written by Jennifer “Coop” Cooper MS, APRN, AGACNP-BC, Sergeant, US Army (veteran)

Click here for the original blog post written by Jennifer Cooper MS, APRN for BuildMyHealth.

The post Postop Recovery Tips first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Want to offer patients the perfect patient experience when it comes to their surgical procedure? Then there’s one thing the doctor must do: be in 100% control of the perioperative (pre-, intra-, and postop-) experience. And to do that, the doctor must have their own office-based operating room.

That time I just missed providing the perfect patient experience

While I do have my own accredited operating room in my office, one of my patients wanted to use her insurance for her breast reduction. If you can prove shoulder or back pain, insurance may cover the cost of your procedure. But be careful. It’s not always a sure thing. Read this to better understand the risks (yes the risks!) of using your insurance if you have a high deductible health plan for outpatient procedures. But I digress.

Anyway, the operation at the hospital went smoothly in the operating room. In the immediate postop period in the recovery room, things were great as well. I checked on the patient in the recovery room and she was appreciative. Since she was stable, I left the hospital.

As far as I knew, it was the perfect patient experience. But then the patient called a few days later. She said she was happy with her results but she had to get something off her chest (no pun intended). She said the last interaction she had that day was with the nurse in Phase II of the recovery room (the phase right before being discharged home), According to the patient, the nurse – the very last interaction the patient had among many interactions that day –  was rude and very dismissive of her pain.

So even though the operation was a success and overall the experience was uneventful, there was one and only one interaction that ruined it all.

Controlling the entire experience in an office-based operating room

A nurse or any employee in my office would not be that dismissive of a patient, including a postop patient. One, they know it’s unacceptable. But two, they know they’re going to see that patient at their postop appointment. It would be awkward seeing a patient again that they were previously rude to in the recovery room. Being in control of the entire perioperative experience, including the personnel, is the only way to provide the perfect patient experience.

I’m not saying that every doctor’s office that has their own operating room can provide a perfect patient experience. Certainly patient perception is also a factor in their experience. We can attempt to manage a patient’s expectations, but even still, they may perceive a less than perfect experience. All we as clinicians can do is provide the perfect experience (whether they know it or not)! And if a perfect patient experience is to be had, it will only occur if the doctor has their own operating room and 360 degree control of the entire process.

As the story above demonstrates, you don’t know who the patient will interact with in a hospital or surgery center during the perioperative process. Even in the operating room, you don’t always know who your operating room staff will be at a hospital or outpatient facility. Having new staff in each operation isn’t only a problem for the patient experience, it can even lead to complications and a poor outcome as this study out of Harvard reveals.

Pros and cons of having your own operating room

The vertical integration of an operating room into an office has its ups and downs. There is the issue of hiring excellent staff and the added cost.  But that is easily outweighed by providing a better experience for the patient, staff and doctor.

Of course it’s not possible for every doctor to have their own operating room in their office. This may not apply to every surgical specialty. However, these same principles can be adapted to address inefficiencies in the hospital setting to the extent it is possible. For example, in many hospitals, the heart surgeons lease the operating room from the hospital and hire all of the staff for the OR.

In this way, they are able to better control the perioperative experience for their patients. And at the same time, they have the necessary supporting services (heart lung machine, ICU, cardiac rehab, etc). So when seeing a surgeon in consultation for a procedure, ask if they are the “master of their domain” (the OR)! They’ll be taken aback by the question, but it could be the difference between a wonderful, mediocre or poor experience.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Perfect patient experience? The doctor has to have their own operating room first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.