Laparoscopic surgery: Failure to recognise post-operative deterioration

Laparoscopic surgery is increasingly common and recovery is usually rapid. Complications, including bowel perforations or bile duct injuries, are rare and may be recognised during the operation with steps taken to mitigate harm. However, there is an under-recognised risk that they can remain undiagnosed until post-operative life threatening complications such as circulatory collapse or septic shock develop. Careful monitoring of vital signs and using early warning scores such as Modified Early Warning Score (MEWS) or Paediatric Early Warning Score (PEWS) during the recovery period is essential.

This alert is for immediate action in organisations where laparoscopic surgery is carried out in the NHS and Independent Sector.

Organisations must ensure that:

1. Local protocols

• specify the observations required in the immediate post operative period to help staff recognise and act upon signs of deterioration;
• define discharge criteria, including senior medical review, if the patient does not meet these criteria;
• define facilities for ongoing care when discharge would be unsafe.

2. When a patient is discharged, systems are in place to ensure

• patients and carers are given:
- a copy of their discharge summary;
- verbal and written advice about signs of deterioration and when to seek medical advice;
- the contact numbers to access urgent medical advice for at least the first 24 hours.

• staff responsible for answering these contact numbers have access to local protocols for action

• a copy of the discharge letter is sent to the patient’s GP within 24 hours.