Signs of complications after colorectal surgery

Colorectal surgical patients often are discharged from the hospital with vague guidance on how to recognize complications, but researchers at the Michael E. DeBakey Veterans Administration (VA) Medical Center and Baylor College of Medicine, both in Houston, aim to change that scenario.

A research team convened surgical experts to develop a list of postoperative complication signs that should prompt colorectal surgical patients to call their surgeons or go to an emergency department. The study on the development of this early patient-centered warning system appears in the February 2013 issue of Journal of the American College of Surgeons.1

Research has shown that 11.4% of all colorectal surgical patients are back in the hospital 30 days later.

The Patient Protection and Affordable Care Act (ACA) allows the Centers for Medicare & Medicaid Services (CMS) to decline payment to hospitals for some patients who are readmitted after being discharged. “Many hospitals are looking at ACA and readmissions,” said study author Linda T. Li, MD, research fellow at the Houston VA Health Services Research Center of Excellence and surgical resident at Baylor. “We’re trying to see if the discharge process has anything to do with readmissions. Everything is under scrutiny.”

The panel of surgeons came up with symptoms that should prompt patients to contact their surgeons:

  • wound drainage, opening, or redness;
  • no bowel movement or lack of gas/stool from any ostomy for more than 24 hours;
  • increasing abdominal pain;
  • vomiting;
  • abdominal swelling;
  • high ostomy output and/or dark urine or no urine;
  • fever greater than 101.5;
  • not being able to take anything by mouth for more than 24 hours.

The panel also identified two symptoms that are serious enough to warrant a trip to the nearest emergency department:

  • chest pain;
  • shortness of breath.

Reference

  1. Li LT, Mills WL, Gutierrez AM, et al. Patient-centered early warning system to prevent readmission after colorectal surgery: a national consensus using the Delphi method. JACS 2013: 216(2): 210-216.e6.