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Patient Safety: Signs of a Post-Operative Infection and What to Do About Them

In my last post, I talked about things you can do to lower your chances of having an infection after your operation. Now let’s talk about the signs and symptoms of infections and what to do if you experience them.

Of course, infections come in all shapes and sizes, from pneumonia and urinary tract infections to skin infections to abscesses. Each presents in its own way, and some can be a challenge for your healthcare team to diagnose.

A key thing to remember about surgery is that you should feel better, and your wound should look better, every day after the operation. If you start feeling worse, or your wound starts looking worse, you should let your doctor know right away. 

Here are some general patient safety principles:

Fevers:
 

It’s actually normal for you have a slightly higher temperature in the first couple of days after an operation (see this abstract). Your body is at work healing your incisions, which can raise your temperature a little bit. Low-grade fevers (less than 101.5 degrees Fahrenheit) can also be caused by partial collapse of your lungs, called atelectasis, which sounds scary but is common after surgery and can usually be fixed by taking deep breaths and coughing. Fevers higher than 101.5 are the greatest cause for concern, and may be a sign of an infection somewhere.

What to do if you have a fever of 101.5 or higher: Call your surgeon’s office right away or go to the emergency room (ideally the ER at the hospital where you had your operation, so they will have all your records immediately available).

Redness:
 

A little bit of redness around your incision (the medical term is “erythema”) is normal. Your body directs more blood cells to the area to speed up the healing process, and that makes the skin around it red. But that redness should be just in the area immediately around your incision, and it shouldn’t spread. If you have increasing redness, or redness with increasing pain, that can be a sign of an infection. 

What to do if you have increasing redness or redness with increasing pain: Call your surgeon’s office – they may want you to come in for an evaluation. If you have a digital camera or camera phone, take a picture of your wound and offer to email it to your surgeon’s office. While some wound infections have to be seen in person to be diagnosed, a good photograph may be enough for your surgeon to know whether you need to come in to the office or not. And if you’re not sure if the redness around your incision is spreading, take a skin-safe marker and trace the edges. If the redness expands outside your marks, call your doctor.

Skin Swelling and Fluid Collections:
 

If your skin tone makes it hard to see the redness of your wound, there are other signs to look for. Hardening of the skin around your incision can be caused by infection-induced swelling (called “induration”). Another sign of infection is the buildup of fluid under your incision, making it feel sort of like a water balloon when you press on it (called “fluctuance”).

What to do if you have skin hardening or fluid build-up near the incision: Call your surgeon.

Discharge:
 

It’s common for surgical incisions to have a little bit of drainage. This should taper off within a few days after surgery. If your wound starts draining a lot – soaking through multiple gauze pads in a day, for instance – or if a once-dry wound starts draining, you might have an infection. And any drainage from your wound should be a light yellow (“serous”) or pink (“serosanginous”) and shouldn’t have any odor. Thick fluid, blood, or fluid with a foul smell coming from the incision are signs of infection.

What to do if you notice discharge that changes in volume or has an unusual color or any odor: Call your doctor immediately.

How Infections Are Treated
 

What can you expect if you have a post-operative infection? It depends on what sort of infection you have, of course. A mild pneumonia or urinary tract infection usually gets better with a course of antibiotics by mouth, though more serious infections could require IV antibiotics for a week or so. These can sometimes be delivered at home.

Wound infections of the skin can sometimes be treated with antibiotics but often require opening the skin up to allow the wound to drain. This sounds a lot scarier than it actually is – the opened skin will close on its own and leave a scar not much bigger than skin that’s had stitches. 

Sometimes infections can occur below the level of the skin. For example, infections in the abdomen can cause fluid collections that can’t be seen on the skin but that cause symptoms such as fevers and abdominal pain. These infections may need to be drained with a procedure that is usually done by interventional radiologists, either while you are an inpatient or as an outpatient procedure. That’s a whole topic unto itself…look for more in upcoming blog posts. 

Remember that all of these problems I’ve described here are rare. The rate of post-operative infections in most elective surgery is between 1% and 5%.

Disclaimer: Keep in mind that the information in this blog is not intended to be medical advice. It’s important to follow the instructions and guidance of your doctor and healthcare team, which might be different than the information provided here.

Jonathan Emerson Kohler, MD, MA, is a senior resident in General Surgery at the University of Washington. A writer and former journalist, he holds an MD with honors from the University of Chicago and a master’s degree in health communications from Emerson College. He is particularly interested in improving the way surgeons communicate with their patients, and in studying how improved communication can lead to better outcomes. You can follow him on Twitter: www.twitter.com/jekohler

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