Editing Perioperative mortality (section)

==Complications following surgery==

===Infection===
{{main|Hospital-acquired infection}}
Countries with a low human development index (HDI) carry a disproportionately greater burden of surgical site infections (SSI) than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of the World Health Organization (WHO) recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication.<ref>{{Cite book |last=Organization |first=World Health |url=https://iris.who.int/handle/10665/277399 |title=Global guidelines for the prevention of surgical site infection |date=2018 |publisher=World Health Organization |isbn=978-92-4-155047-5 |language=en}}</ref><ref>{{Cite web |date=2019-04-11 |title=Overview {{!}} Surgical site infections: prevention and treatment {{!}} Guidance {{!}} NICE |url=https://www.nice.org.uk/guidance/ng125 |access-date=2023-11-16 |website=www.nice.org.uk}}</ref><ref>{{Cite journal |last1=Gwilym |first1=Brenig L. |last2=Ambler |first2=Graeme K. |last3=Saratzis |first3=Athanasios |last4=Bosanquet |first4=David C. |last5=Stather |first5=Philip |last6=Singh |first6=Aminder |last7=Mancuso |first7=Enrico |last8=Arifi |first8=Mohedin |last9=Altabal |first9=Mohamed |last10=Elhadi |first10=Ahmed |last11=Althini |first11=Abdulmunem |last12=Ahmed |first12=Hazem |last13=Davies |first13=Huw |last14=Rangaraju |first14=Madhu |last15=Juszczak |first15=Maciej |date=August 2021 |title=Groin Wound Infection after Vascular Exposure (GIVE) Risk Prediction Models: Development, Internal Validation, and Comparison with Existing Risk Prediction Models Identified in a Systematic Literature Review |journal=European Journal of Vascular and Endovascular Surgery |volume=62 |issue=2 |pages=258–266 |doi=10.1016/j.ejvs.2021.05.009 |issn=1078-5884|doi-access=free |pmid=34246547 |hdl=1983/8e17b0f2-2b9e-4c7f-947b-82f0535b1ffb |hdl-access=free }}</ref><ref>{{cite journal | vauthors = Bhangu A, Ademuyiwa AO, Aguilera ML, Alexander P, Al-Saqqa SW, Borda-Luque G, etal | title = Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study | journal = The Lancet. Infectious Diseases | volume = 18 | issue = 5 | pages = 516–525 | date = May 2018 | pmid = 29452941 | pmc = 5910057 | doi = 10.1016/S1473-3099(18)30101-4 | collaboration = GlobalSurg Collaborative }}</ref>

Local infection of the operative field is prevented by using [[asepsis|sterile technique]], and [[Chemoprophylaxis|prophylactic antibiotics]] are often given in abdominal surgery or patients known to have a heart defect or [[Artificial heart valve|mechanical heart valves]] that are at risk of developing [[endocarditis]].<ref>{{Cite journal |last1=Gwilym |first1=Brenig L. |last2=Dovell |first2=George |last3=Dattani |first3=Nikesh |last4=Ambler |first4=Graeme K. |last5=Shalhoub |first5=Joseph |last6=Forsythe |first6=Rachael O. |last7=Benson |first7=Ruth A. |last8=Nandhra |first8=Sandip |last9=Preece |first9=Ryan |last10=Onida |first10=Sarah |last11=Hitchman |first11=Louise |last12=Coughlin |first12=Patrick |last13=Saratzis |first13=Athanasios |last14=Bosanquet |first14=David C. |date=2021-04-01 |title=Editor's Choice – Systematic Review and Meta-Analysis of Wound Adjuncts for the Prevention of Groin Wound Surgical Site Infection in Arterial Surgery |journal=European Journal of Vascular and Endovascular Surgery |volume=61 |issue=4 |pages=636–646 |doi=10.1016/j.ejvs.2020.11.053 |issn=1078-5884|doi-access=free |pmid=33423912 |hdl=1983/47254b47-dcd3-4819-9cee-5c22a7ce7b04 |hdl-access=free }}</ref><ref>{{Cite journal |last1=Gwilym |first1=Brenig L. |last2=Ambler |first2=Graeme K. |last3=Saratzis |first3=Athanasios |last4=Bosanquet |first4=David C. |last5=Stather |first5=Philip |last6=Singh |first6=Aminder |last7=Mancuso |first7=Enrico |last8=Arifi |first8=Mohedin |last9=Altabal |first9=Mohamed |last10=Elhadi |first10=Ahmed |last11=Althini |first11=Abdulmunem |last12=Ahmed |first12=Hazem |last13=Davies |first13=Huw |last14=Rangaraju |first14=Madhu |last15=Juszczak |first15=Maciej |date=2021-08-01 |title=Groin Wound Infection after Vascular Exposure (GIVE) Risk Prediction Models: Development, Internal Validation, and Comparison with Existing Risk Prediction Models Identified in a Systematic Literature Review |journal=European Journal of Vascular and Endovascular Surgery |volume=62 |issue=2 |pages=258–266 |doi=10.1016/j.ejvs.2021.05.009 |issn=1078-5884|doi-access=free |pmid=34246547 |hdl=1983/8e17b0f2-2b9e-4c7f-947b-82f0535b1ffb |hdl-access=free }}</ref>

Methods to decrease surgical site infections in spine surgery include the application of antiseptic skin preparation (a.g. Chlorhexidine gluconate in alcohol which is twice as effective as any other antiseptic for reducing the risk of infection<ref>{{cite journal |last1=Wade |first1=Ryckie G. |last2=Burr |first2=Nicholas E. |last3=McCauley |first3=Gordon |last4=Bourke |first4=Grainne |last5=Efthimiou |first5=Orestis |title=The Comparative Efficacy of Chlorhexidine Gluconate and Povidone-iodine Antiseptics for the Prevention of Infection in Clean Surgery: A Systematic Review and Network Meta-analysis |journal=Annals of Surgery |date=1 September 2020 |volume= 274|issue=6 |pages=e481–e488 |doi=10.1097/SLA.0000000000004076|pmid=32773627 |doi-access=free }}</ref>), judicious use of surgical drains, prophylactic antibiotics, and vancomycin.<ref>{{cite journal | vauthors = Pahys JM, Pahys JR, Cho SK, Kang MM, Zebala LP, Hawasli AH, Sweet FA, Lee DH, Riew KD | display-authors = 6 | title = Methods to decrease postoperative infections following posterior cervical spine surgery | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 95 | issue = 6 | pages = 549–54 | date = March 2013 | pmid = 23515990 | doi = 10.2106/JBJS.K.00756 }}</ref> Preventative antibiotics may also be effective.<ref>{{cite journal | vauthors = James M, Martinez EA | title = Antibiotics and perioperative infections | journal = Best Practice & Research. Clinical Anaesthesiology | volume = 22 | issue = 3 | pages = 571–84 | date = September 2008 | pmid = 18831304 | doi = 10.1016/j.bpa.2008.05.001 }}</ref>

Whether any specific dressing has an effect on the risk of surgical site infection of a wound that has been sutured closed is unclear.<ref>{{cite journal | vauthors = Dumville JC, Gray TA, Walter CJ, Sharp CA, Page T, Macefield R, Blencowe N, Milne TK, Reeves BC, Blazeby J | display-authors = 6 | title = Dressings for the prevention of surgical site infection | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD003091 | date = December 2016 | issue = 12 | pmid = 27996083 | pmc = 6464019 | doi = 10.1002/14651858.CD003091.pub4 }}</ref>

A 2009 [[Cochrane (organisation)|Cochrane]] [[systematic review]] aimed to assess the effects of strict blood glucose control around the time of operation to prevent SSIs. The authors concluded that there was insufficient evidence to support the routine adoption of this practice and that more [[randomized controlled trial]]s were needed to address this research question.<ref>{{cite journal | vauthors = Kao LS, Meeks D, Moyer VA, Lally KP | title = Peri-operative glycaemic control regimens for preventing surgical site infections in adults | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD006806 | date = July 2009 | pmid = 19588404 | pmc = 2893384 | doi = 10.1002/14651858.cd006806.pub2 }}</ref>

===Blood clots===
Examples are [[deep vein thrombosis]] and [[pulmonary embolism]], the risk of which can be mitigated by certain interventions, such as the administration of [[anticoagulant]]s (e.g., [[warfarin]] or [[low molecular weight heparin]]s), [[antiplatelet drug]]s (e.g., [[aspirin]]), [[compression stockings]], and [[Sequential compression device|cyclical pneumatic calf compression]] in high risk patients.{{Citation needed|date=August 2011}}

===Lungs===
Many factors can influence the risk of postoperative pulmonary complications (PPC).  (A major PPC can be defined as a postoperative pneumonia, respiratory failure, or the need for reintubation after extubation at the end of an anesthetic.  Minor post-operative pulmonary complications include events such as atelectasis, bronchospasm, laryngospasm, and unanticipated need for supplemental oxygen therapy after the initial postoperative period.) <ref>{{cite journal | vauthors = Cook MW, Lisco SJ | title = Prevention of postoperative pulmonary complications | journal = International Anesthesiology Clinics | volume = 47 | issue = 4 | pages = 65–88 | year = 2009 | pmid = 19820479 | doi = 10.1097/aia.0b013e3181ba1406 | s2cid = 9060298 }}</ref>  Of all patient-related risk factors, good evidence supports patients with advanced age, ASA class II or greater, functional dependence, chronic obstructive pulmonary disease, and congestive heart failure, as those with increased risk for PPC.<ref name="Smetana 2006 581–595">{{cite journal | vauthors = Smetana GW, Lawrence VA, Cornell JE | title = Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians | journal = Annals of Internal Medicine | volume = 144 | issue = 8 | pages = 581–95 | date = April 2006 | pmid = 16618956 | doi = 10.7326/0003-4819-144-8-200604180-00009 | s2cid = 7297481 | doi-access =  }}</ref>  Of operative risk factors, surgical site is the most important predictor of risk for PPCs (aortic, thoracic, and upper abdominal surgeries being the highest-risk procedures, even in healthy patients.<ref>{{cite journal | vauthors = Smetana GW | s2cid = 20581319 | title = Postoperative pulmonary complications: an update on risk assessment and reduction | journal = Cleveland Clinic Journal of Medicine | volume = 76 | issue = Suppl 4 | pages = S60-5 | date = November 2009 | pmid = 19880838 | doi = 10.3949/ccjm.76.s4.10 | doi-access = free }}</ref>  The value of preoperative testing, such as spirometry, to estimate pulmonary risk is of controversial value and is debated in medical literature.  Among laboratory tests, a serum albumin level less than 35 g/L is the most powerful predictor and predicts PPC risk to a similar degree as the most important patient-related risk factors.<ref name="Smetana 2006 581–595"/>

[[Respiratory therapy]] has a place in preventing [[pneumonia]] related to [[atelectasis]], which occurs especially in patients recovering from thoracic and abdominal surgery.{{Citation needed|date=August 2011}}.

===Neurologic===
[[Stroke]]s occur at a higher rate during the postoperative period.{{Citation needed|date=July 2011}}

===Livers and kidneys===
In people with [[cirrhosis]], the perioperative mortality is predicted by the [[Child-Pugh score]].<ref>{{Citation |last=Tsoris |first=Andrea |title=Use Of The Child Pugh Score In Liver Disease |date=2025 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK542308/ |access-date=2025-03-08 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=31194448 |last2=Marlar |first2=Clinton A.}}</ref>

=== Postoperative fever ===
[[Postoperative fever]]s are a common complication after surgery and can be a hallmark of a serious underlying sepsis, such as pneumonia, [[urinary tract infection]], [[deep vein thrombosis]], wound infection, etc. However, in the early post-operative period a low-level fever may also result from anaesthetic-related [[atelectasis]], which will usually resolve normally.{{citation needed|date=February 2022}}