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Moath Omar Aljabri et al, 2020;4(2):481–485.

International Journal of Medicine in Developing Countries

Common surgical problems: a brief review

Moath Omar Aljabri1*, Faris Adnan Mohammed Baawad2, Hassan Saud Alshehri3, Dalia Abdulelah A Murshid4, Mohammed Ahmed Mohammed Alyazidy2, Omar Abdulrahman Almakhayitah5, Hussain Omar Bogari2

Correspondence to: Nader Alrahili

*Maternity and Children Hospital, Tabuk, Saudi Arabia.

Email: moathaljabri11 [at] gmail.com

Full list of author information is available at the end of the article.

Received: 04 December 2019 | Accepted: 18 December 2019


ABSTRACT

Surgical complications vary from minor-to-major serious events. Surgical complications have a significant negative impact on different aspects of patients‘life such as the psychology of patients and duration for recovery. The current study was aimed at reviewing studies on surgical complications. A systematic literature search was performed on online databases Google Scholar and Pubmed database using specific keywords. The publications published between 2000 and 2019, without any date or language restrictions were retrieved. Among 41 articles initially selected based on the title and abstract, 28 articles were excluded as they were either duplicate or published before the year 2000 or were non-relevant. Finally, 13 articles were selected and included in the review. The study found that the rate of post-operative complications depends on the several factors, the urgent management of these complications is necessary to avoid morbidities.


Keywords:

Surgical, complications, prevalence, classification.


Introduction

Surgical complications represent a significant challenge for surgical patients. These complications vary from minor which can be resolved to major serious events that can be life-threatening and requiring multiple interventions [1]. It was found that postoperative complications can contribute to an increase in care at discharge, duration of stay, and mortality [2]. Postoperative complications are associated with higher risks of hospital readmission and mortality [36]. Complications are stated in surgical literature as important outcome measures and they are used as indicators for measuring quality. Using complications for this purpose has a weak point which is the reliability of the complication reporting process [7]. Both of definitions used for complications and the validity of the recording system are the fundamental basis for the incidence of recorded complications [8,9]. There are different classification systems to classify complications [1012]. Clavien et al. [9] proposed definitions for postoperative complications and classification system to grade the severity of complications based on invasiveness and type of treatment required to treat such complications. A revised version of the classification system was proposed in 2004, it was based on the same principle, except for the length of hospital stay [1]. The revised classification is composed of five categories from grade I to grade V depending on their need for more or less treatment [1]. The surgical complication has a significant impact on the life of patients as it is a significant long-term indicator of postoperative psychological outcomes of the patients [13]. They may contribute to psychological distress, such as anxiety and depression, because of inherent challenges associated with prolonged recovery [13]. The recovery of patients can be delayed as a result of psychological distress resulted from surgical complications as this stress compromise immunity [1416] and delay wound healings [17,18]. So, this review was performed to overview the surgical complications.


Data Search

A systematic literature search was performed on online databases Google Scholar and Pubmed database using specific keywords “complications, surgical complications, postoperative complications, prevalence, and management.” The publications published between 2000 and 2019, without any date or language restrictions were retrieved. Among 41 articles initially selected based on the title and abstract, 28 articles were excluded as they were either duplicate or published before the year 2000 or were non-relevant. Finally, 13 articles were selected and included in the review.


Discussion

Classification of complications

The original definition of complication was set by Clavien et al. [9] and he defined complications as “unexpected events not intrinsic to the procedure. In 1992, the Clavien-Dindo classification was originated, it was first introduced under the name “T92 score” as validated on 650 cholecystectomies [9]. This scoring system could compare surgical and conservative treatments, compare results over different periods within the same institution, compare different institutions, and document operations and associated complications in a standard manner, which facilitate meta-analysis. Moreover, prognostic scores could be implemented [19]. In 2004, an updated version was presented when separate suffix for permanent disability and new subcategories were introduced. The length of stay was discarded in this new system by Clavien and Dindo [1]. The modification of this classification system expanded the classification to five grades containing seven levels of severity [1]. The amended classification added precision by requiring information regarding whether the intervention provoked by the complications involved a general anesthetic, whether intensive care unit (ICU) admission for organ failure was needed and if so complications were subdivided by the extent of organ failure present [20].

Prevalence of different complications

In the US, the number of annual surgical procedures performed continues to rise with more than 14 million admissions for surgical procedure as reported in 2006 [21]. It was reported that the rate of postoperative complications can reach to 30% in some patient groups [22,23], while almost 1% of surgical procedures lead to mortality [24]. The risk of complications in surgery is higher than in general medicine by 2- to 5-folds and almost 40% of in-hospital complications are related to surgical procedures [25,26]. It is difficult to precisely estimate the risk for complications occurrence, however, it was noted that the range of risk from 3% to 17% among surgical patients in developed countries [27]. Major urgent surgery, advanced age, and co-morbid disease are associated with an increased risk of postoperative complications [2830]. The incidence of postoperative pain varies depending on degree, group of patients and surgical procedure, it was reported that severe pain after surgery was prevalent among 59% as reported in 2003 from the US [31], whereas the prevalence of moderate pain 24 hours after surgery was reported to be 31% and the severe pain was 22.3% [32]. Nausea and vomiting are other post-operative complications, their incidence is almost 50% and 30%, respectively, and the incidence may be increased to 80% in the case of patients with a high risk of postoperative pain and nausea [33]. Major complications often occur after major abdominal surgery and quoted at around 25% [34]. In one study, two different systems were used to classify complications, one was developed by the trauma registry of the American College of Surgeons and the other by the association of surgery of the Netherlands. The study reported that colorectal surgery was performed for 505 patients, and there were 437 complications were recorded in 181 patients of the total number of patients and 80% of these events represented 13 types of complications [35]. Moreover, the study reported that anastomotic disruption was the most serious complication recorded after colorectal surgery and it was recorded as dehiscence 32 times (80%) according to the association of surgery of the Netherlands system, whereas according to trauma registry of American College of Surgeons, anastomotic leak was reported 24 times (60%) [35]. Postoperative acute kidney injury (AKI) is a potentially common devastating complication. Based on consensus criteria, AKI affects 30% of surgical patients and is associated with increased risk for other major complications such as respiratory failure, prolonged stay in the ICU, sepsis, and cardiovascular complications [24]. Reduction of the number and severity of complications can be achieved by appropriate risk stratification of patients before the operation and promote the timely initiation of intra-operative prevention strategies [36]. In gynecological surgery, the prevalence of surgical complications varies depending on the patients. It was reported that the prevalence of complications was 3.7% as reported by the American College of Surgeons [37], 8.9% as reported by Brazil reports [38], 12.5% as reported by Colombia reports [39]. Brummer et al. [40] reported a higher overall rate of complications 11.7%. The outcome of the surgery is affected by co-morbidities, medical history, sociodemographic conditions, equipment and experience of the surgeon, as well as indications of the procedure [37]. The most common complication is surgical site infection with a prevalence of 2.2%–10% [38,39,41,42], followed by transfusion, reoperation, pelvic abscesses and wound dehiscence by rates of 4%, 2%, 1.5%, and 1.5%, respectively [39,42]. There are some other complications associated with gynecological surgery, including, fever (0.47%), bowel injury (0.4%), urethral injury (0.25%), urinary tract injury (0.3%–1%), bleeding (0.06%), and rectal perforation (0.09%) [39,43]. Emergency laparotomy is associated with high rates of postoperative complications, hospital stay, and mortality [4449]. Complications including intestinal obstruction, bowel ischemia, perforated viscus and hemorrhage [47].

Surgical complications management

Improvement programs for surgical quality are becoming more prevalent to improve surgical outcomes. The goal is to measure outcomes and identify improvement areas to reduce the morbidity and mortality of patients [2]. Other tools have been developed to improve postoperative outcomes and reduce the length of stay [50], including checklists [51] and several clinical protocols that include detailed steps for the care of patients depending on their clinical status [52]. Post-operative complications can be either specific to the type of surgery or general, they must be managed when they occur with consideration of the clinical characteristics of the patient [52].


Conclusion and Recommendations

The prevalence of postoperative complications can’t be precisely determined as they vary depending on several factors such as the type of surgery. The study found that the rate of post-operative complications depends on several factors, the urgent management of these complications is necessary to avoid morbidities. There were no reviews or studies focused on the prevalence of general complications after surgery as well as their management, so further studies are recommended.


List of Abbreviations

AKI Acute kidney injury
ICU Intensive care unit

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Not applicable.


Ethical approval

Not applicable.


Author details

Moath Omar Aljabri1, Faris Adnan Mohammed Baawad2, Hassan Saud Alshehri3, Dalia Abdulelah A Murshid4, Mohammed Ahmed Mohammed Alyazidy2, Omar Abdulrahman Almakhayitah5, Hussain Omar Bogari2

  1. Maternity and children hospital, Tabuk, Saudi Arabia
  2. King Abdulaziz University, Jeddah, Saudi Arabia
  3. Security Forced hospital, Jeddah, Saudi Arabia
  4. Arabian Gulf University, Bahrain
  5. King Faisal University, Alahsa, Saudi Arabia

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How to Cite this Article
Pubmed Style

Aljabri MO, Baawad FAM, Alshehri HS, Murshid DAA, Alyazidy MAM, Almakhayitah OA, Bogari HO. Common surgical problems: a brief review. IJMDC. 2020; 4(2): 481-485. doi:10.24911/IJMDC.51-1575497306


Web Style

Aljabri MO, Baawad FAM, Alshehri HS, Murshid DAA, Alyazidy MAM, Almakhayitah OA, Bogari HO. Common surgical problems: a brief review. https://www.ijmdc.com/?mno=76644 [Access: October 15, 2021]. doi:10.24911/IJMDC.51-1575497306


AMA (American Medical Association) Style

Aljabri MO, Baawad FAM, Alshehri HS, Murshid DAA, Alyazidy MAM, Almakhayitah OA, Bogari HO. Common surgical problems: a brief review. IJMDC. 2020; 4(2): 481-485. doi:10.24911/IJMDC.51-1575497306



Vancouver/ICMJE Style

Aljabri MO, Baawad FAM, Alshehri HS, Murshid DAA, Alyazidy MAM, Almakhayitah OA, Bogari HO. Common surgical problems: a brief review. IJMDC. (2020), [cited October 15, 2021]; 4(2): 481-485. doi:10.24911/IJMDC.51-1575497306



Harvard Style

Aljabri, M. O., Baawad, . F. A. M., Alshehri, . H. S., Murshid, . D. A. A., Alyazidy, . M. A. M., Almakhayitah, . O. A. & Bogari, . H. O. (2020) Common surgical problems: a brief review. IJMDC, 4 (2), 481-485. doi:10.24911/IJMDC.51-1575497306



Turabian Style

Aljabri, Moath Omar, Faris Adnan Mohammed Baawad, Hassan Saud Alshehri, Dalia Abdulelah A Murshid, Mohammed Ahmed Mohammed Alyazidy, Omar Abdulrahman Almakhayitah, and Hussain Omar Bogari. 2020. Common surgical problems: a brief review. International Journal of Medicine in Developing Countries, 4 (2), 481-485. doi:10.24911/IJMDC.51-1575497306



Chicago Style

Aljabri, Moath Omar, Faris Adnan Mohammed Baawad, Hassan Saud Alshehri, Dalia Abdulelah A Murshid, Mohammed Ahmed Mohammed Alyazidy, Omar Abdulrahman Almakhayitah, and Hussain Omar Bogari. "Common surgical problems: a brief review." International Journal of Medicine in Developing Countries 4 (2020), 481-485. doi:10.24911/IJMDC.51-1575497306



MLA (The Modern Language Association) Style

Aljabri, Moath Omar, Faris Adnan Mohammed Baawad, Hassan Saud Alshehri, Dalia Abdulelah A Murshid, Mohammed Ahmed Mohammed Alyazidy, Omar Abdulrahman Almakhayitah, and Hussain Omar Bogari. "Common surgical problems: a brief review." International Journal of Medicine in Developing Countries 4.2 (2020), 481-485. Print. doi:10.24911/IJMDC.51-1575497306



APA (American Psychological Association) Style

Aljabri, M. O., Baawad, . F. A. M., Alshehri, . H. S., Murshid, . D. A. A., Alyazidy, . M. A. M., Almakhayitah, . O. A. & Bogari, . H. O. (2020) Common surgical problems: a brief review. International Journal of Medicine in Developing Countries, 4 (2), 481-485. doi:10.24911/IJMDC.51-1575497306