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ICU TopicsCardiovascular / perioperative

ICU · Cardiovascular / perioperative

Postoperative Complications in the ICU

Also known as Postoperative complications · Postop complications · Postoperative bleeding · Postoperative respiratory failure · Postoperative delirium · Postoperative AKI · VTE prophylaxis · ERAS · Enhanced recovery after surgery

Exam-focused guide to postoperative complications in intensive care: bleeding, pulmonary complications, infection, cardiac events, delirium, acute kidney injury, fluids, analgesia, venous thromboembolism and enhanced recovery pathways.

high34 referencesUpdated 26 July 202610 min readSource-verified · Oct 2026

Checked against its sources on 23 Oct 2026

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Practise this topic8 MCQs with explanations

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CICMFFICMEDIC
The one-paragraph fellowship answer

Postoperative complications are common: in the International Surgical Outcomes Study of 44 814 elective in-patient surgical patients, 16.8% sustained at least one postoperative complication and 0.5% died before hospital discharge. Checklist exposure was associated with reduced mortality (OR 0.49) but no difference in complication rates.[1]

Meet the patient

A 68-year-old man, Day 2 after an emergency laparotomy for a perforated diverticulum. Tachycardic at 118, afebrile, BP holding. Drain output is modest, but the lactate has crept to 2.6 and the urine output has tailed off. He sits on a morphine PCA, an epidural running, and a litre of Hartmann's an hour. He has not yet got out of bed.[1]

The ward-round question that decides his night: is this pain, an anastomotic leak, MINS, or fluid overload? Each one needs a different phone call. This topic is how you tell them apart before 3am.[1]

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References34ShowHide
  1. [1]Abbott TEF, Ahmad T, Phull MK, et al. The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis. British Journal of Anaesthesia, 2018.PMID 29397122
  2. [2]Devereaux PJ, Yang H, Yusuf S, et al Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet, 2008.PMID 18479744
  3. [3]Devereaux PJ, Mrkobrada M, Sessler DI, et al Aspirin in patients undergoing noncardiac surgery. N Engl J Med, 2014.PMID 24679062
  4. [4]Devereaux PJ, Biccard BM, Sigamani A, et al. Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery. JAMA, 2017.PMID 28444280
  5. [5]Myles PS, Bellomo R, Corcoran T, et al. Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery. N Engl J Med, 2018.PMID 29742967
  6. [6]Oodit R, Biccard BM, Panieri E, et al. Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low-Middle-Income Countries (LMIC's): Enhanced Recovery After Surgery (ERAS) Society Recommendation. World journal of surgery, 2022.PMID 35641574
  7. [7]Lassen K, Soop M, Nygren J, et al Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg, 2009.PMID 19841366
  8. [8]Thompson A, Fleischmann KE, Smilowitz NR, et al. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2024.PMID 39316661
  9. [9]Miskovic A, Lumb AB Postoperative pulmonary complications. Br J Anaesth, 2017.PMID 28186222
  10. [10]Odor PM, Bampoe S, Gilhooly D, et al. Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis. BMJ, 2020.PMID 32161042
  11. [11]Brower RG, Matthay MA, Morris A, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med, 2000.PMID 10793162
  12. [12]Futier E, Constantin JM, Paugam-Burtz C, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med, 2013.PMID 23902482
  13. [13]Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation, 1999.PMID 10477528
  14. [14]Wijeysundera DN, Pearse RM, Shulman MA, et al. Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study. Lancet, 2018.PMID 30070222
  15. [15]Bergqvist D, Agnelli G, Cohen AT, et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med, 2002.PMID 11919306
  16. [16]Dobrev D, Aguilar M, Heijman J, et al. Postoperative atrial fibrillation: mechanisms, manifestations and management. Nat Rev Cardiol, 2019.PMID 30792496
  17. [17]Diallo EH, Brouillard P, Raymond JM, et al. Predictors and impact of postoperative atrial fibrillation following thoracic surgery: a state-of-the-art review. Anaesthesia, 2023.PMID 36632006
  18. [18]Rosenberg H, Pollock N, Schiemann A, et al. Malignant hyperthermia: a review. Orphanet J Rare Dis, 2015.PMID 26238698
  19. [19]Wick EC, Grant MC, Wu CL Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques: A Review. JAMA Surg, 2017.PMID 28564673
  20. [20]Bell RF, Dahl JB, Moore RA, et al. Perioperative ketamine for acute postoperative pain. Cochrane Database Syst Rev, 2006.PMID 16437490
  21. [21]Weibel S, Jelting Y, Pace NL, et al. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery in adults. Cochrane Database Syst Rev, 2018.PMID 29864216
  22. [22]Gumbert SD, Kork F, Jackson ML, et al. Perioperative Acute Kidney Injury. Anesthesiology, 2020.PMID 31687986
  23. [23]Ostermann M, Auzinger G, Grocott M, et al. Perioperative fluid management: evidence-based consensus recommendations from the international multidisciplinary PeriOperative Quality Initiative. Br J Anaesth, 2024.PMID 39341776
  24. [24]Magruder JT, Belmustakov S, Ohkuma R, et al. Attributable harm of severe bleeding after cardiac surgery in hemodynamically stable patients. Gen Thorac Cardiovasc Surg, 2017.PMID 27650660
  25. [25]Bhattacharya M, Kallet RH, Ware LB, et al. Negative-Pressure Pulmonary Edema. Chest, 2016.PMID 27063348
  26. [26]Lagier D, Zeng C, Fernandez-Bustamante A, et al. Perioperative Pulmonary Atelectasis: Part II. Clinical Implications. Anesthesiology, 2022.PMID 34710217
  27. [27]Møller AM, Villebro N, Pedersen T, et al. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet, 2002.PMID 11809253
  28. [28]Keating GM Sugammadex: A Review of Neuromuscular Blockade Reversal. Drugs, 2016.PMID 27324403
  29. [29]Huang Y, Tang SR, Young CJ, et al. Nonsteroidal anti-inflammatory drugs and anastomotic dehiscence after colorectal surgery: a meta-analysis. ANZ J Surg, 2018.PMID 29164809
  30. [30]Ha ACT, Verma S, Mazer CD, et al. Effect of Continuous Electrocardiogram Monitoring on Detection of Undiagnosed Atrial Fibrillation After Hospitalization for Cardiac Surgery: A Randomized Clinical Trial. JAMA Netw Open, 2021.PMID 34448866
  31. [31]Serpa Neto A, Hemmes SN, Barbas CS, et al. Protective versus Conventional Ventilation for Surgery: A Systematic Review and Individual Patient Data Meta-analysis. Anesthesiology, 2015.PMID 25978326
  32. [32]Devereaux PJ, Chan MT, Alonso-Coello P, et al. Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery. JAMA, 2012.PMID 22706835
  33. [33]American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults. Journal of the American Geriatrics Society, 2015.PMID 25495432
  34. [34]Halvorsen S, Mehilli J, Choorapoikayil S, et al. Extract from the 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery - Patient Blood Management. Blood transfusion = Trasfusione del sangue, 2024.PMID 38063786

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