Surgical site infections (SSIs) occur in 2-5% of clean surgical procedures and up to 18% of contaminated procedures in veterinary patients. Early recognition and appropriate management significantly reduce morbidity. Use the Wound Assessment AI for wound evaluation and the Drug Formulary for perioperative drug protocols.
Intra-operative hemorrhage results from ligature slippage, vessel transection, or coagulopathy. Prevention includes meticulous technique, appropriate ligature sizing, and pre-operative coagulation screening for at-risk patients (thrombocytopenic, hepatopathic, anticoagulant exposure).
Post-operative hemorrhage presents as tachycardia, pale mucous membranes, prolonged CRT, declining PCV/TS, abdominal distension (internal bleeding), or incisional swelling (subcutaneous bleeding). Mild oozing from the incision within the first 24 hours is common; progressive hemorrhage requires surgical exploration.
Management: direct pressure for external hemorrhage, IV crystalloid and colloid resuscitation, blood typing and crossmatching for transfusion, and surgical re-exploration for ongoing internal bleeding.
| Wound Classification | Definition | Expected Infection Rate | Example |
|---|---|---|---|
| Clean | No hollow viscus entered; no inflammation | 2-5% | Ovariohysterectomy, mass removal |
| Clean-Contaminated | Hollow viscus entered with minimal spillage | 4-10% | Cystotomy, enterotomy (controlled) |
| Contaminated | Gross spillage, open trauma <4 hrs | 10-15% | Intestinal foreign body with spillage |
| Dirty | Established infection, devitalized tissue | 15-40% | Ruptured pyometra, septic peritonitis |
SSI signs include erythema, swelling, warmth, pain, and purulent discharge, typically appearing 3-7 days post-operatively. Obtain culture and sensitivity before starting antibiotics. Superficial SSI may respond to wound lavage and systemic antibiotics; deep SSI may require incision and drainage, debridement, or open wound management.
Warning: Perioperative prophylactic antibiotics should be given as a single IV dose (cefazolin 22 mg/kg) within 60 minutes of skin incision, repeated every 90 minutes intra-operatively. Continuing antibiotics beyond 24 hours post-operatively for clean procedures increases resistance without reducing SSI rates.
Dehiscence is the partial or complete separation of a surgical wound. Risk factors include infection, excessive tension, hypoalbuminemia (<2.0 g/dL), obesity, corticosteroid use, patient interference (licking/chewing), and poor surgical technique (suture placed too close to wound edge, inappropriate suture material).
Recognition: serous or serosanguinous discharge from the incision line, visible separation of wound edges, and in the case of abdominal dehiscence, evisceration (a surgical emergency).
Management depends on severity: superficial dehiscence in a clean wound may be managed with second-intention healing or re-closure under local anesthesia. Full-thickness abdominal dehiscence requires emergency surgical exploration, lavage, and re-closure with strong tension-relieving suture patterns.
Seroma: Accumulation of serous fluid in dead space. Non-painful, fluctuant, develops 3-7 days post-op. Most resolve spontaneously within 2-3 weeks. Do NOT aspirate unless very large or uncomfortable (aspiration introduces infection risk). Prevent with dead space closure, pressure bandaging, and activity restriction.
Hematoma: Accumulation of blood in tissue. Develops within 24-48 hours. May be painful, firm, and discolored. Small hematomas resorb spontaneously. Large, expanding hematomas may require surgical exploration to identify and ligate the bleeding vessel.
Anesthetic complications: Hypotension (MAP <60 mmHg), hypothermia, bradycardia, and delayed recovery are common. Pre-operative risk assessment using ASA classification, appropriate monitoring (ECG, SpO2, ETCO2, blood pressure), and active warming reduce incidence.
Thromboembolic disease: Pulmonary thromboembolism (PTE) is an underdiagnosed complication associated with hypercoagulable states (immune-mediated hemolytic anemia, protein-losing nephropathy, hyperadrenocorticism, neoplasia). Clinical signs include acute dyspnea, tachypnea, and cardiovascular collapse. Diagnosis is challenging; CT angiography is gold standard.
Post-operative ileus: Reduced or absent GI motility following abdominal surgery, especially involving the GI tract. Clinical signs include vomiting, inappetence, and absence of borborygmi. Management includes prokinetics (metoclopramide CRI 1-2 mg/kg/day), early enteral nutrition, and correction of electrolyte abnormalities (hypokalemia).
Use the General Vet AI for case-by-case guidance on managing complex post-operative complications and planning patient monitoring protocols.
- Know the wound classification system: clean, clean-contaminated, contaminated, dirty, and their expected SSI rates.
- Perioperative antibiotics: single dose of cefazolin within 60 minutes of incision for appropriate cases only.
- Dehiscence risk factors: infection, hypoalbuminemia, obesity, corticosteroids, and patient interference.
- Do not aspirate seromas unless absolutely necessary; most resolve spontaneously in 2-3 weeks.
- Post-operative ileus management includes metoclopramide CRI, early enteral nutrition, and electrolyte correction.
- Systematic post-operative monitoring with clear complication recognition criteria prevents delayed treatment.