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Post-operative Care Fat Embolism Compartment Syndrome
Home | Articles | Presentations | Post-operative Care

Post-operative Care

Last updated 14th May 2021

Bloods

  1. All patients require FBC & U&E done 24 hours post-op
  2. CRP is expected to be raised 3-4 days after operation. Therefore DO NOT request these unless looking for post-op infection specifically

X-ray

Elective patients

  1. THR – AP pelvis
  2. TKR – Left/ Right knee AP & Lateral
  3. Shoulder replacement – Left / Right true AP shoulder (in scapular plane) & Scapular Y view

Trauma patients (NOF #)

  1. Hemiarthroplasty – Pelvis AP
  2. Femoral nails – Right/ Left Full length femur AP & Lateral
  3. Tibial nails – Right/ Left Full length Tib & Fib AP & Lateral

Thromboprophylaxis

  1. These differ based on the surgeon & type of operation. This is usually specified in the operative note, however if in doubt, check with the registrar. 
  2. Antiplatelets (aspirin & clopidogrel) – restart these once haemostasis is secured
  3. LMWH (for patients not on anticoagulants usually) – Dalteparin 5000 units
    • Elective TKR – 2/52 LMWH
    • Elective THR – 4/52 LMWH
    • Trauma – total hip replacement – 4/52 LMWH
    • Trauma – Hemiarthroplasty/ DHS/ IM nail – generally 4/52 LMWH (read post-op instruction)
  4. Warfarin
    • Depending on surgeon’s preferences, restart warfarin at normal dose post-op when haemostasis is secure (usually 48 hours post op). There is no need for loading dose regimen unless pt is on warfarin for unprovoked DVT/PE or metallic heart valve
    • Continue LMWH until INR therapeutic for 2 days 
  5. DOAC
    • When haemostasis is secure, restart at usual dose when eating and >12 hours from last dose of LMWH

Delirium/ Sepsis

  1. Due to demographics of patients who are admitted especially with NOF#, these patients are susceptible to post-op delirium/ sepsis
  2. Always go through A-E assessment
  3. Common causes
    • UTI – beware of false positive in patients with long term catheter
    • Atelectasis
      Most common source of fever on day 1 post-op
      Pain control is very important – ensure adequate analgesia is given as taking shallow breaths due to pain can be harmful
      Chest physiotherapy – this usually includes blowing into saline bottles 
      Can progress to pneumonia
    • CAP/ HAP
    • Hyponatraemia
      Commonly seen post-op as surgery predisposes SIADH
      Look at  volume status and follow investigations for hyponatraemia

Discharge Planning

  1. Analgesia – ensure adequate analgesia is given. This usually depends on what the patient has been getting as an inpatient however co-codamol 30/500 2 tablets QDS +/- Oromorph 10mg 4 hourly is reasonable
  2. Laxatives – Important to ensure patients are opening their bowels regularly especially if on co-codamol and oromorph. Laxido/ Bisacodyl is reasonable
  3. Thromboprophylaxis
  4. Stitches/ clips to be removed either by practise nurses or district nurses
    THR/ TKR – Usually in 7-10 days post-op
  5. Review in clinic
    Elective THR/TKR patients – review in surgeons clinic in 6 weeks time
    Trauma patients – depending on type of surgery, to confirm with operating team