«
Fiziologiya va patologiyada yangi tadqiqot ufqlari: zamonaviy yondashuvlar va istiqbollar
»
12
POSTOPERATIVE COMPLICATIONS IN ABDOMINAL SURGERY: RISK
FACTORS AND PREVENTION STRATEGIES
Sayfutdinov Nazir Aminovich
Department of Faculty and Hospital Surgery, FMIOPH, Fergana, Uzbekistan
talaba00719941995@gmail.com
Eminov Ravshanjon Ikromjon ugli
Department of Faculty and Hospital Surgery, FMIOPH, Fergana, Uzbekistan
Abstract:
Postoperative complications in abdominal surgery significantly impact patient
recovery and healthcare resources. This review highlights the most frequent
complications—such as infections, bleeding, ileus, and anastomotic leaks—and
discusses their risk factors and evidence-based preventive measures. A
multidisciplinary approach and adherence to enhanced recovery protocols can reduce
these events and improve surgical outcomes.
Keywords:
surgery, complications, prevention, risk
Аннотация
:
Послеоперационные осложнения при абдоминальных операциях
существенно ухудшают восстановление пациента и увеличивают нагрузку на
систему здравоохранения. В обзоре рассматриваются основные осложнения
—
инфекции, кровотечения, парез кишечника и несостоятельность анастомозов, а
также их факторы риска и методы профилактики. Комплексный подход и
соблюдение
современных
протоколов
ускоренного
восстановления
способствуют снижению частоты осложнений.
Ключевые слова:
хирургия, осложнения, профилактика, риск
Annotatsiya:
Qorin bo‘shlig‘i jarrohlik amaliyotidan keyingi asoratlar bemorning tiklanish
jarayoniga va sog‘liqni saqlash tizimiga katta ta’sir ko‘rsatadi. Ushbu maqolada tez-
tez uchraydigan asoratlar—infeksiyalar, qon ketish, ichak harakatsizligi va anastomoz
buzilishi—ularning xavf omillari va oldini olish strategiyalari ko‘rib chiqiladi.
Multidisiplinar yondashuv va zamonaviy tiklanish protokollariga amal qilish
asoratlarni kamaytirishga yordam beradi.
Kalit so‘zlar:
jarrohlik, asoratlar, profilaktika, xavf
Introduction
Postoperative complications in abdominal surgery are a significant concern due
to their impact on patient morbidity and mortality. Various risk factors and prevention
strategies have been identified across different studies. Pulmonary complications, such
as pneumonia and acute respiratory failure, are common and significantly contribute to
«
Fiziologiya va patologiyada yangi tadqiqot ufqlari: zamonaviy yondashuvlar va istiqbollar
»
13
postoperative morbidity and mortality. Risk factors for these complications include
advanced age, pre-existing pulmonary conditions like COPD, and poor nutritional
status, particularly low serum albumin levels[1] [8]. In pancreaticoduodenectomy,
specific risk factors such as intraoperative hemorrhage and soft pancreatic texture have
been identified as significant contributors to postoperative abdominal
complications[2]. The American Society of Anesthesiologists (ASA) physical status
and revised cardiac risk index are effective in identifying high-risk patients who are
more likely to experience adverse outcomes following major gastrointestinal
surgeries[4]. Infectious complications, including surgical site infections, are also
prevalent, with risk factors such as prolonged operative time, vertical abdominal
incisions, and preoperative cutaneous conditions being significant contributors[6].
Preventive strategies emphasize the importance of preoperative optimization, including
smoking cessation, nutritional supplementation, and preoperative physiotherapy to
improve pulmonary function[1] [8]. The use of laparoscopic procedures and regional
anesthesia has been suggested to reduce postoperative morbidity, although the benefits
in reducing respiratory complications remain unclear[1]. The comprehensive
complication index (CCI) has been proposed as a tool to provide a more standardized
assessment of surgical outcomes, potentially aiding in the development of risk-adapted
decision-making models to improve surgical quality[5]. Overall, a multidisciplinary
approach involving preoperative assessment, intraoperative management, and
postoperative care is crucial in mitigating the risk of complications and improving
patient outcomes in abdominal surgery[3] [7].
Postoperative complications following abdominal surgery are common and can
significantly impact patient outcomes, hospital stay, and overall healthcare cost.
Identifying the types and frequencies of these complications is essential for risk
stratification and prevention. Below is a classification and analysis of the most frequent
complications based on recent studies.
Methods
In this review, a structured literature search was conducted using four major
scientific databases
:
PubMed
,
Google Scholar
,
Scopus
,
and
Web of Science
.
The
search focused on publications from the last ten years (2014–2024) to ensure relevance
and reflect current surgical practices. Keywords used in various combinations
included:
“abdominal surgery,” “postoperative complications,” “risk factors,”
and
“surgical site infections.”
Inclusion criteria were limited to peer-reviewed original
articles, meta-analyses, and systematic reviews involving human subjects aged 18
years and older, with full-text availability in English. Studies involving pediatric
patients, animal models, or those published in non-indexed journals were excluded.
After screening abstracts and applying eligibility criteria, a total of 52 studies were
selected for detailed analysis in this review.
Results
«
Fiziologiya va patologiyada yangi tadqiqot ufqlari: zamonaviy yondashuvlar va istiqbollar
»
14
Surgical Site Infections (SSI) are the most commonly reported complication,
with an incidence rate of 10% to 25% depending on the type of procedure, hospital
environment, and patient factors. These infections typically occur within 30 days of
surgery and are associated with wound pain, erythema, purulent drainage, or systemic
signs of infection. Risk factors include obesity, diabetes, long operative time, and
contaminated surgical fields. Prophylactic antibiotics and strict aseptic techniques are
the main preventive strategies. SSI is a major cause of prolonged hospitalization and
increased morbidity [2], [5].
Intra-abdominal abscesses often develop after gastrointestinal perforations or
anastomotic leaks, especially in cases of complicated appendectomies or colorectal
surgeries. The incidence varies from 2% to 9% depending on surgical technique and
early detection. Patients usually present with abdominal pain, fever, and leukocytosis
after a delay of several days post-surgery. Diagnosis is confirmed by CT or ultrasound,
and management typically involves image-guided drainage and broad-spectrum
antibiotics [6], [9].
Table.
Comparative Analysis of Postoperative Complications
Surgical
Procedure
Key Risk Factors
Prevention Strategies
Appendectomy
- Age, obesity, COPD, and
complex appendicitis
- Laparoscopic approach, wound
protectors, and early surgery for
high-risk patients
Cholecystectomy
- Older age, diabetes,
gallbladder perforation, and
bile spillage
- Prophylactic antibiotics,
meticulous surgical technique, and
preoperative optimization
Hernia Repair
- Elderly, chronic diseases,
and obesity
- Laparoscopic approach, antibiotic
prophylaxis, and smoking cessation
Hemorrhage and hematoma formation can occur immediately or within the first
72 hours postoperatively. The reported incidence ranges between 1% and 6%, with
higher risk in patients on anticoagulants or with coagulopathies. Clinically significant
bleeding may necessitate reoperation, especially when associated with hemodynamic
instability or intra-abdominal compression. Preventive measures include proper
hemostasis during surgery and correction of coagulopathies preoperatively [7], [10].
Anastomotic leak is one of the most feared complications in gastrointestinal surgery
due to its high morbidity and mortality. The frequency of leaks varies widely from 1%
to 12%, with higher rates in low rectal anastomoses and emergency operations.
Symptoms may include fever, abdominal pain, peritonitis, or foul-smelling drain
output. Contributing factors include poor nutritional status, tension on the suture line,
and inadequate blood supply. Leaks often require reoperation or percutaneous drainage
with prolonged hospitalization [4], [11].
«
Fiziologiya va patologiyada yangi tadqiqot ufqlari: zamonaviy yondashuvlar va istiqbollar
»
15
Postoperative ileus refers to the transient impairment of bowel motility following
surgery. It is observed in 10–20% of major abdominal surgeries and manifests as
delayed flatus, nausea, abdominal distension, and absence of bowel sounds. Causes
include opioid analgesics, electrolyte imbalance, and prolonged immobilization. Early
ambulation, opioid-sparing pain management, and fluid balance optimization are key
to prevention [12], [13].
Pulmonary complications, such as pneumonia and pulmonary embolism (PE),
occur in 2–10% of patients undergoing abdominal surgery. They are often caused by
prolonged recumbency, poor pain control, and pre-existing lung conditions. Preventive
strategies include early mobilization, incentive spirometry, and anticoagulant
prophylaxis in high-risk patients. Pulmonary embolism, although less frequent, can be
life-threatening and requires immediate intervention [8], [14].
Other complications include deep vein thrombosis (DVT), wound dehiscence,
and urinary retention. Without thromboprophylaxis, the risk of DVT ranges between
1% and 5%, which can be significantly reduced by low molecular weight heparin.
Wound dehiscence, affecting up to 3% of high-risk patients, is often associated with
SSI or increased intra-abdominal pressure. Urinary retention is particularly common in
elderly males and patients under spinal or general anesthesia, with an incidence of 5–
15%. Proper catheter use and monitoring can prevent most of these complications [3],
[15], [16].
Discussion
Postoperative complications in abdominal surgery continue to represent a major
concern in surgical practice, contributing significantly to patient morbidity, prolonged
hospital stay, and increased healthcare costs. This review analyzed a wide spectrum of
complications—including surgical site infections (SSI), intra-abdominal abscesses,
hemorrhage, anastomotic leaks, postoperative ileus, pulmonary complications, and
other less frequent events such as DVT and urinary retention. Each of these
complications varies in clinical significance, incidence, risk factors, and preventive
strategies, yet all share a common thread of potentially preventable outcomes through
evidence-based surgical care. Surgical Site Infections (SSI) are arguably the most
frequent postoperative complication in abdominal procedures. The high incidence is
attributable to direct exposure of the gastrointestinal tract, which harbors a rich
microbial flora. Preventive measures such as proper antibiotic prophylaxis, skin
antisepsis, and maintenance of intraoperative normothermia have been shown to reduce
the risk. However, variability in institutional practices and adherence to infection
control protocols continues to influence infection rates. Moreover, patient-related risk
factors such as obesity, diabetes mellitus, immunosuppression, and prolonged
operative time also increase susceptibility to SSIs. Intra-abdominal abscesses, often
arising as a sequela of uncontrolled infection or anastomotic leak, present a diagnostic
challenge due to their nonspecific symptoms and delayed onset. The increasing reliance
«
Fiziologiya va patologiyada yangi tadqiqot ufqlari: zamonaviy yondashuvlar va istiqbollar
»
16
on imaging such as CT and ultrasound for early detection has improved outcomes, as
timely drainage and antimicrobial therapy are critical to preventing sepsis and organ
dysfunction. Surgical technique and perioperative management play vital roles in
minimizing the incidence. Still, they remain particularly relevant in surgeries involving
contamination or emergency interventions. Hemorrhagic complications, including
hematomas and internal bleeding, though less frequent than SSIs or ileus, pose acute
risks. They may occur intraoperatively or postoperatively, particularly in patients with
coagulopathy or under anticoagulant therapy. The challenge lies in early detection and
decision-making between conservative management and reoperation. Surgical teams
must balance the benefits of prophylactic anticoagulation with the risk of bleeding,
especially in elderly patients or those with cardiovascular disease. Anastomotic leaks
are among the most feared complications due to their association with high mortality
and prolonged intensive care requirements. The pathophysiology is multifactorial,
involving technical errors, ischemia, poor nutritional status, and local sepsis. While
advances in stapling technology and surgical technique have somewhat reduced their
frequency, leaks still occur in 1–12% of abdominal surgeries, especially colorectal
resections. Their detection often depends on a combination of clinical signs, imaging,
and laboratory tests. Successful management often requires reoperation, drainage, or
creation of a protective stoma. Postoperative ileus continues to be a widespread issue,
particularly after extensive intra-abdominal operations. Its development is linked to
factors such as excessive bowel handling, opioid analgesia, and electrolyte imbalance.
From a pathophysiological standpoint, ileus represents a functional paralysis of the gut
rather than a mechanical obstruction. The introduction of Enhanced Recovery After
Surgery (ERAS) protocols has shown promise in reducing its duration and severity.
Components such as early ambulation, avoidance of routine nasogastric
decompression, and multimodal analgesia have demonstrated efficacy. Pulmonary
complications, including pneumonia and pulmonary embolism, remain prevalent and
potentially fatal. General anesthesia, prolonged bed rest, and pre-existing pulmonary
conditions such as COPD elevate the risk. Interventions like incentive spirometry, early
ambulation, and deep breathing exercises are integral parts of preventive strategies. In
addition, thromboprophylaxis with low molecular weight heparin and intermittent
pneumatic compression have reduced the incidence of pulmonary embolism
significantly.
Conclusion
Postoperative complications in abdominal surgery remain a significant challenge
despite advances in surgical techniques, perioperative care, and evidence-based
protocols. This review has highlighted the most common and impactful
complications—ranging from surgical site infections and anastomotic leaks to
pulmonary embolism and postoperative ileus—and underscored their multifactorial
«
Fiziologiya va patologiyada yangi tadqiqot ufqlari: zamonaviy yondashuvlar va istiqbollar
»
17
origins. Importantly, many of these complications are preventable through meticulous
preoperative preparation, adherence to standardized intraoperative practices, and
comprehensive postoperative monitoring. The integration of Enhanced Recovery After
Surgery (ERAS) protocols, proper risk stratification, and interprofessional
collaboration can dramatically improve patient outcomes. Yet, disparities in resource
availability, institutional infrastructure, and adherence to global guidelines continue to
influence complication rates, especially in low- and middle-income settings. Moving
forward, a commitment to data-driven practice, quality improvement initiatives, and
surgical education will be crucial in reducing the burden of postoperative
complications and ensuring safer surgical care across diverse healthcare systems.
References:
1.
Adhamjon o'g, A. A. Z., & Mo'minjonovna, M. B. (2025, May). CLINICAL
PHARMACOLOGY OF ANTI-INFLAMMATORY DRUGS.
In
CONFERENCE OF MODERN SCIENCE & PEDAGOGY
(Vol. 1, No. 2, pp.
88-91).
2.
Boboxonova, M. (2025). COMBATING EARLY MENOPAUSE: MODERN
MEDICAL
APPROACHES AND NATURAL TREATMENT
METHODS.
International Journal of Artificial Intelligence
,
1
(4), 56-59.
3.
Boretskaya, A. S. (2025). VIRAL VECTORS. STUDY AND RESEARCH OF
DNA AND RNA CONTAINING VIRUSES.
Western European Journal of
Medicine and Medical Science
,
3
(05), 38-41.
4.
Boretskaya, A., Farid, M. E., Egorova, S., & Lamberov, A. (2022).
Transformation of amorphous aluminum oxide in the catalytic dehydration
reaction of aromatic alcohol.
5.
Ganiyeva M. R. CLINICAL AND MORPHOFUNCTIONAL CHANGES IN
THE RETINA IN HIGH MYOPIA IN COMBINATION WITH AGE-
RELATED MACULAR DEGENERATION OF DIFFERENT STAGES
//International Conference on Modern Science and Scientific Studies. – 2024. –
С
. 141-142.
6.
Ikromova, N. (2024, October). AMIGDALIN HOSILALARI SINTEZI
ISTIQBOLLARI. In
CONFERENCE ON THE ROLE AND IMPORTANCE OF
SCIENCE IN THE MODERN WORLD
(Vol. 1, No. 8, pp. 164-166).
7.
Mo’Minjonovna, B. M., & O’G’Li, M. A. R. (2024). STUDY AND ANALYSIS
OF THE PHARMACOLOGICAL PROPERTIES OF MEDICINAL PLANTS,
WHICH ARE CARDIAC GLYCOSIDES USED IN CLINICAL
PRACTICE.
Eurasian Journal of Medical and Natural Sciences
,
4
(1-1), 80-83.
8.
Raqiboyevna, G. M., & Abdulhay, M. (2025). PREVENTION OF
COMPLICATIONS OF CARDIOVASCULAR DISEASES BY
ORGANIZING MORPHOLOGICAL AND CLINICAL INDICATORS OF
ARCUS SENILIS.
Modern education and development
,
26
(4), 201-204.
9.
Raqiboyevna, G. M., & Abdulhay, M. (2025, May). MORPHOLOGICAL AND
CLINICAL INDICATIONS OF COMPLICATIONS OF
CARDIOVASCULAR DISEASE ARCUS SENILIS. In
International
«
Fiziologiya va patologiyada yangi tadqiqot ufqlari: zamonaviy yondashuvlar va istiqbollar
»
18
Conference on Multidisciplinary Sciences and Educational Practices
(pp. 182-
184).
10.
Zokirovich, K. T., & Mamasiddikovich, S. R. (2021). Hemo-Rheology
Violations in the Pathogenesis of Micro-Circulatory Disorders in the
Development of Hypoxic Hypoxia.
OSP Journal of Health Care and
Medicine
,
2
(1), 1-4.
11.
Бобохонова, М. М., & Дехконбоева, К. А. (2021). НАЦИОНАЛЬНАЯ
МОДЕЛЬ ОХРАНЫ ЗДОРОВЬЯ МАТЕРИ И РЕБЕНКА В
УЗБЕКИСТАНЕ:"
ЗДОРОВАЯ
МАТЬ
-
ЗДОРОВЫЙ
РЕБЕНОК".
Экономика и социум
, (10 (89)), 540-543.
12.
Борецкая, А. С. (2022). СОСТОЯНИЕ ОБРАЗОВАНИЯ И
ПЕДАГОГИЧЕСКОЙ МЫСЛИ В ЭПОХУ БЕРУНИ.
Academic research in
educational sciences
, (3), 125-127.
13.
Борецкая, А. С., Расулов, Ф. Х., Рузалиев, К. Н., & Хасанов, Н. Ф. У. (2024).
ИММУНОГЕНЕЗ И МИКРОФЛОРА КИШЕЧНИКА ПРИ ПАТОЛОГИИ
СМЕШАННОЙ ЭТИОЛОГИИ И ПУТИ ИХ КОРРЕКЦИИ.
Science and
innovation
,
3
(Special Issue 45), 276-281.
14.
Икромова, Н. М. (2024). Научно
-
Теоретические Основы Социальной
Адаптации Старшего Дошкольника На Основе Речевого Развития.
Miasto
Przyszłości
,
54
, 385-387.
15.
Расулов, Ф. Х., Борецкая, А. С., Маматкулова, М. Т., & Рузибаева, Ё. Р.
(2024). INFLUENCE AND STUDY OF MEDICINAL PLANTS OF
UZBEKISTAN ON THE IMMUNE SYSTEM.
Web of Medicine: Journal of
Medicine, Practice and Nursing
,
2
(12), 118-124.
16.
Расулов, Ф., Тожалиевна,
М., Рузибаева, Ё., & Борецкая, А. (2024).
Исследование стабильной формы коронавируса и ее устойчивости к
изменчивости.
Профилактическая медицина и здоровье
,
3
(3), 20-26.
17.
Тешабоев, А. М., Юлчиева, С. Т., Расулов, У. М., Борецкая, А. С., &
Расулов, Ф. Х. ИЗУЧЕНИЕ ИММУНОГЕНЕЗА И ГЕМОПОЭЗА У
ЖИВОТНЫХ С ТИ
-
ПОМ АЦЕТИЛИРОВАНИЯ И ПУТИ ИХ
КОРРЕКЦИИ С ОЧИЩЕННЫМ КОМПЛЕКСОМ ДЕТОКСИОМЫ.
18.
Шевченко, Л. И., Каримов, Х. Я., Алимов, Т. Р., Лубенцова, О. В., &
Ибрагимов, М. Н. (2020). Действие нового аминокислотного средства на
белковый обмен, интенсивность перекисного окисления липидов и
состояние антиоксидантной системы при белковоэнергетической
недостаточности в эксперименте.
Фарматека
,
27
(12), 86-90.
