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Surgery · USMLE Step 2 CK

USMLE Step 2 CK Surgery: Postoperative Complications

Common postoperative complications and their management, from wound infection to anastomotic leak, tested on USMLE Step 2 CK.

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What is the most common cause of postoperative fever within the first 24-48 hours?
Atelectasis.
Postoperative fever on postop day 3-5 is classically attributed to what cause?
Urinary tract infection.
Postoperative fever on postop day 5-7 raises suspicion for what complication?
Deep vein thrombosis.
Postoperative fever on postop day 7-10 is classically caused by what?
Surgical wound infection.
Postoperative fever after day 10 should raise concern for what complications?
Deep abscess or anastomotic leak.
The classic mnemonic for causes of postoperative fever by timing is the ____ (Wind, Water, Walking, Wound, Wonder drugs/deep abscess).
5 Ws
What bedside interventions reduce atelectasis after surgery?
Incentive spirometry and early ambulation.
What is the most common bacterial cause of surgical wound infection?
Staphylococcus aureus.
What is the definition of wound dehiscence?
Separation of the fascial layers of a surgical incision.
What is the classic presenting sign of wound dehiscence?
Sudden discharge of pink (serosanguineous) fluid from the incision.
What are major risk factors for wound dehiscence?
Obesity, poor nutrition, wound infection, increased intra-abdominal pressure, and steroid use.
What is evisceration?
Protrusion of abdominal viscera through a fully separated wound.
What is the immediate bedside management of evisceration?
Cover the exposed bowel with sterile saline-soaked gauze and arrange emergent surgical closure.
What is the hallmark early symptom of necrotizing fasciitis?
Pain out of proportion to physical exam findings.
What is the definitive treatment for necrotizing fasciitis?
Emergent surgical debridement.

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