Post-surgical Recovery

Surgical procedures can have a significant effect on a patients' physical and emotional state, both before and after treatment. Pain and immobility following any surgical procedure are common. The transition from being independent and asymptomatic to sometimes dependent can be difficult.

Recovery after any type of surgery is a very personal experience. Your recovery is influenced by a number of factors; type of surgery and the reason for it, complexity of the procedure, type of anaesthetic and length of time under anaesthetic, your health and fitness leading up to the surgery, pain levels following surgery along with possible work and family disturbance due to the surgery.

Your length of stay in hospital will be very much dependent on what and how the surgery was performed. In the first days after surgery after open abdominal surgery the nursing staff will play a significant role in helping you to a speedy recovery. They will show and help you to change your position in bed initially. You will be expected to change your position from lying on your back to your side every two hours. Getting in and out of bed with a painful/sore wound can be difficult. Swelling around the wound can make the sutures somewhat tighter and movement puts tension on the wound. Any incision causes trauma and swelling to the surrounding tissue with accompanying emotional stress. Application of compression to the wound reduces swelling and improves healing. Research has shown that applying compression to a wound following surgery reduces pain and allows easier mobility. Early mobilisation is not only encouraged but recommended after any abdominal surgery to reduce the risk of deep vein Thrombosis (DVT). You may also be given additional medication to further reduce this risk. This again will depend on the type of surgery performed and also any underlying risk factors you may have.

To support your wound and surrounding muscles SRC SurgiHeal Shorts will provide support and compression to your wound but will also increase muscle support and allow you to be more mobile sooner, subsequently reducing the risk of DVT.

For the first few weeks following your abdominal surgery, your body heals by making scar tissue; this is where collagen is deposited into the wound area which is what makes the scar take on a raised, dark red appearance. Compression may also reduce the wound from developing a thickened scar.

As with any surgical procedure there are possible side effects associated with it. Feeling tired is very common so try to get as much rest as possible. Wound pain should decrease significantly over the first week; the use of gentle compression on the wound will help enormously with this. Once you get discharged home you will require help for the first weeks to avoid damage to the healing wound.

Signs and Symptoms that require you to contact your Doctor/Surgeon after you have been discharged home.

Nausea and Vomiting

Raised Temperature

Wound changes; increased redness, pain or discharge.

Calf pain

Frequency of and burning when urinating

References

The Effect of Abdominal Support on Functional Outcomes in Patients Following Major Abdominal

Surgery: A Randomized Controlled Trial. Physiotherapy Can. 2010; 62:242–25

Oren Cheifetz, S. Deborah Lucy, Tom J. Overend, Jean Crowe

Brooks-Brunn JA. Postoperative atelectasis and pneumonia. Heart Lung. 1995;24:94–115. doi:10.1016/S0147-9563(05)80004-4

Kips JC. Preoperative pulmonary evaluation. Acta Clin Belg. 1997;52:301–5. doi:10.1002/pri.231

Smetana GW. Preoperative pulmonary evaluation. N Engl J Med. 1999;230:937–44.

Deep Vein Thrombosis (DVT)/ Venous Thromboembolism (VTE)

Early mobilisation after conventional knee replacement may reduce the risk of postoperative venous thromboembolism E. O. Pearse, MA, FRCS(Orth), Specialist Registrar in Orthopaedics, Clinical Knee Fellow; B. F. Caldwell, FRACS(Orth), Orthopaedic Surgeon; R. J. Lockwood, BHlth Sc(Nursing), RN Surgical Nursing Unit Manager; and J. Hollard, BMed(Hons), FANZCA, Consultant Anaesthetist.  2007 British Editorial Society of Bone and Joint Surgery

Abstract

We carried out an audit on the result of achieving early walking in total knee replacement after instituting a new rehabilitation protocol, and assessed its influence on the development of deep-vein thrombosis as determined by Doppler ultrasound scanning on the fifth post-operative day. Early mobilisation was defined as beginning to walk less than 24 hours after knee replacement.

Between April 1997 and July 2002, 98 patients underwent a total of 125 total knee replacements. They began walking on the second post-operative day unless there was a medical contraindication. They formed a retrospective control group. A protocol which allowed patients to start walking at less than 24 hours after surgery was instituted in August 2002. Between August 2002 and November 2004, 97 patients underwent a total of 122 total knee replacements. They formed the early mobilisation group, in which data were prospectively gathered. The two groups were of similar age, gender and had similar medical comorbidities. The surgical technique and tourniquet times were similar and the same instrumentation was used in nearly all cases. All the patients received low-molecular-weight heparin thromboprophylaxis and wore compression stockings post-operatively.

In the early mobilisation group 90 patients (92.8%) began walking successfully within 24 hours of their operation. The incidence of deep-vein thrombosis fell from 27.6% in the control group to 1.0% in the early mobilisation group (chi-squared test, p < 0.001). There was a difference in the incidence of risk factors for deep-vein thrombosis between the two groups. However, multiple logistic regression analysis showed that the institution of an early mobilisation protocol resulted in a 30-fold reduction in the risk of post-operative deep-vein thrombosis when we adjusted for other risk factors.

Prevention of Venous Thromboembolism in Surgical Patients

Giancarlo Agnelli, MD (Circulation. 2004;110[suppl IV]:IV-4–IV-12.)

Abstract—Venous thromboembolism (VTE) is a common complication of surgical procedures. The risk for VTE in surgical patients is determined by the combination of individual predisposing factors and the specific type of surgery. Prophylaxis with mechanical and pharmacological methods has been shown to be effective and safe in most types of surgery and should be routinely implemented. For patients undergoing general, gynaecologic, vascular, and major urologic surgery, low-dose unfractionated heparin or low-molecular-weight heparin (LMWH) are the options of choice.

For low-risk urologic surgery, early postoperative mobilization of patients is the only intervention warranted. For higher-risk patients, including those undergoing elective hip or knee replacement and surgery for hip fracture, vitamin K antagonists, LMWH, or fondaparinux are recommended.

For patients undergoing neurosurgery, graduated elastic stockings are effective and safe and may be combined with LMWH to further reduce the risk of VTE. The role of prophylaxis is less defined in patients undergoing elective spine surgery, as well as laparoscopic and arthroscopic surgery. A number of issues related to prophylaxis of VTE after surgery deserve further clarification, including the role of screening for asymptomatic deep vein thrombosis, the best timing for initiation of pharmacological prophylaxis, and the optimal duration of prophylaxis in high-risk patients.