Whilst surgery may often be the only or the most effective treatment for a medical condition, patients and their doctors all accept that surgical procedures inevitably have an element of risk. Surgeons and anaesthetists must assess each patient’s risk before they have an operation, taking into account the patient’s condition and the type of surgery that they are having. The patient should also be informed of known risks, such as common and serious complications of the operation they are agreeing to undergo, to enable them to give informed consent when deciding to undergo the recommended surgical procedure. If a patient suffers harm as a result of negligent surgical technique they may be entitled to compensation. Even where unavoidable complications happen, these must be properly managed for surgical and post-surgical care to be of an acceptable standard. Where avoidable injury is caused by failure to manage a surgical complication or post-operative deterioration in the patient’s condition properly, the injured patient may be entitled to make a claim. Post-operative care The post-operative or recovery period is a particularly risky time for a patient as their condition may change rapidly. The type of care required will depend on the operation and an individual’s own risk factors, including their past medical history. The aim of post-operative care is to support a patient’s recovery (i.e. to prevent complications), and to intervene quickly if signs of deterioration occur. Post-operative complications There are many life-threatening complications which can occur in the post-operative period. They include: Shock (a rapid drop in blood pressure): There are many causes of shock, but they include blood loss, infection or brain injury. Treatments include giving IV blood or fluids, stopping the blood loss, maintaining a patient’s airway and administering medication to increase blood pressure. Haemorrhage (excessive blood loss): A patient may require emergency surgery to identify the source of bleeding and carry out a repair. A blood transfusion may also be necessary. Infection: Bacteria may cause infection at the site of a wound, or internally, at the site of the surgery. Once detected, further surgery may be required, and antibiotics will almost certainly be required, whether given orally or intravenously. If an infection goes untreated, it can spread rapidly to other parts of the body, including the bloodstream, and may ultimately result in sepsis which is a medical emergency. Blood clots: After surgery patients are at a higher risk of developing a blood clot (a deep vein thrombosis), which may break off and travel to other parts of the body causing serious injury, such as pulmonary embolism (lungs), amputation (leg), heart attack, or stroke (brain). Blood thinners (anti-coagulants) may be prescribed to prevent further clots forming, and drugs given to dissolve those clots which have already formed. Surgery may also be required. Avoiding injury With appropriate care, many of these complications can be avoided. For example, blood clots may be prevented with the use of pressure stockings, and infections may be avoided with appropriate wound care. A doctor may be negligent if they fail to take sensible steps to lessen the chance of a recognised problem occurring. However, some complications cannot be avoided, and in these cases it is important that problems are detected and dealt with promptly. In 2012 a National Early Warning Score (NEWS) system was established to help healthcare practitioners monitor and recognise deterioration in a patient’s condition. This works by giving a score to six different physiological markers (respiration rate, oxygen saturation, systolic blood pressure, pulse rate, level of consciousness or new confusion, and temperature). The score indicates how far each of the six markers of the patient’s condition deviates from normal. To be effective, NEWS relies upon observations being taken regularly, scores being calculated correctly, and appropriate action being taken on the basis of those scores. When does negligent post-operative care lead to a claim? Boyes Turner’s medical negligence lawyers are experienced in dealing with serious injury claims arising from poor post-operative care. Examples of post-operative errors leading to successful claims include: Tetraplegia from incorrect post-operative care after spinal surgery We recovered £1.5million lump sum and care payments of £225,000pa for life for a client who suffered tetraplegia when he fell from the hospital chair where he was left to sleep after spinal surgery complicated by a dural tear and leakage of cerebrospinal fluid (CSF). He was readmitted to hospital after discharge with neck and arm pain, headaches and bleeding from his neck wound, but was incorrectly placed on a cardiac ward, where he was left to sleep in a chair. Whilst asleep, he fell out of the chair injuring his cervical spinal cord but his complaint of paralysis was ignored. He was then hoisted into a bed and left without neurological examination or urgent cervical decompression. By the time his condition was diagnosed, he had suffered irreversible tetraplegia. Multiple amputations after post-operative sepsis We obtained a £750,000 settlement for a woman who suffered amputations to both hands and feet, including a below knee amputation and psychological injury, after delayed, inadequate treatment of post-operative sepsis and necrotising fasciitis. She developed sepsis in hospital after surgery on her bowel but her deteriorating condition was treated with inadequate antibiotics. When further surgery revealed that she had a perforated bowel, signs of sepsis and necrotising fasciitis were mistaken for post-operative bruising. Her wounds were surgically cleaned but her infection worsened, and she developed septic shock. She suffered multi-system organ failure, ischaemia, brachial thrombosis and extensive peripheral vascular compromise which led to gangrene in her hands and feet and multiple amputations. Amputation from post-operative thrombosis We secured a £450,000 settlement for a 70-year-old man with a medical history of thrombosis and popliteal vascular disease who suffered a below-knee amputation when his anti-coagulation medication was mismanaged after bladder surgery. He suffered a thrombosis, and lack of blood flow (ischaemia) to his foot, which required amputation. Death from undiagnosed post-operative internal bleeding We recovered £105,000 in compensation for the widower of a woman who died from undiagnosed post-operative internal bleeding. Despite her known risk of bleeding, she was given an insufficient amount of fresh frozen plasma during surgery. After the operation she was not seen by a member of the surgical team, either that day, or the next. Nursing staff were concerned but they did not seek help. Eventually the patient was found to be bleeding internally, but efforts to save her were unsuccessful. If you or a member of your family have suffered serious injury caused by negligent surgical or post-operative care and you would like to find out more about making a claim, contact the medical negligence team by email at firstname.lastname@example.org.