After an Operation

After a low-risk operation, such as knee-replacement surgery, the person may be monitored for only a few hours in a recovery unit or intensive care unit before being moved to a standard hospital room. However, if the low-risk operation is performed on a person with several other disorders, more intensive monitoring is needed. After a high-risk operation, such as one involving the heart or lungs, the person is monitored for several hours in a recovery unit. Recovery units are staffed by nurses and other health care practitioners specifically trained to care for people just out of surgery. In many cases, the person is then moved to an intensive care unit. Intensive care units are staffed by doctors, nurses, and other health care practitioners who are trained to prevent or recognize and quickly treat complications of surgery—even if the operation is uneventful and completed without complications. If no new problems arise after a few days in an intensive care unit, the person is usually moved to a standard hospital room.

After a brief initial recovery period, older people are encouraged to take certain preventive measures, even when convalescence seems to be uncomplicated. Getting out of bed and sitting in a chair is often the first goal. Older people also benefit from getting up to walk as soon as is permitted after surgery. Not doing so may result in many complications of bed rest, such as a rapid loss of muscle strength and an increased risk of pressure sores, blood clots in the legs, and pneumonia. Getting up and about also helps improve digestion and speeds return of normal bowel movements. Older people may need more help, because they are at risk of getting dizzy or of fainting when they attempt to stand. Dizziness or fainting may occur because the body's normal means of regulating blood pressure when changing position adapts more slowly with increasing age.

Complications

Pain: Pain is to be expected after any type of surgery. Older people may be particularly stoic and may not report pain after surgery. If a person is temporarily unable to talk because of the need for an oxygen mask or hoarseness after anesthesia, health care practitioners and family members must be particularly vigilant for indications that the person is experiencing pain. Some hospitals ask people who are unable to talk to view illustrated facial expressions and to point to the one that best depicts the amount of pain they are experiencing. Generally, effective pain control after surgery helps get people back on their feet sooner. It allows for deeper and more effective breathing and improves the ability to function, hastening the person's return to everyday activities. However, doctors must be careful about the type and dosage of drugs used to control pain, because older people are at high risk of side effects from some drugs used to control pain, particularly opioid analgesics. Side effects of opioid analgesics include confusion, drowsiness, nausea, constipation, urinary retention (causing excessive urine to remain in the bladder after urinating), and impaired breathing (slower and shallower than normal).

Confusion: Some degree of sudden confusion (delirium) occurs in many older people in the first week after surgery. Delirium seems to increase the risk of other complications, and it can prolong a hospital stay. For example, people with delirium may remove devices such as tubes draining the bladder, intravenous tubing, or wound drains. Or, they may fall and injure themselves when getting out of bed.

Several factors increase the risk of developing delirium. One is the use of certain drugs, such as opioid analgesics and drugs with anticholinergic effects, just before, during, and after surgery. A sudden imbalance of fluids and dissolved salts (electrolytes) in the body, lack of or disruption of sleep, and lack of reminders and cues about time and where one is also contribute to delirium. People with dementia who undergo surgery are particularly susceptible to delirium.

If delirium does develop, possible causes are remedied as quickly as possible. At the same time, steps to ensure the person's safety are undertaken. Having someone in constant attendance (for example, a family member or special aide) is always preferable to using physical or chemical restraints. If sedatives are used, low doses of short-acting drugs are best.

Confusion persists in some older people after surgery. This type of problem is most likely with coronary artery bypass surgery and other long, complicated operations.

Undernutrition: Special nutritional support is needed for people who were malnourished before surgery and for people who cannot resume normal eating immediately after surgery. Supplements are sometimes needed and are given by mouth whenever possible. If swallowing is impaired, doctors may place a temporary feeding tube through the esophagus and into the stomach or small intestine. If digestion or absorption of nutrients is impaired, doctors can give nutrition intravenously.

See the table Some Potential Complications of Surgery.