Urgent Concerns: Managing Complications After Major Surgery in Elderly Patients

I would like to ask for your help?

Hello Doctor: My father was involved in a serious car accident, which resulted in injuries to his left femur and thigh bone, leading to major surgery.
At that time, medical technology was not very advanced, so he had an artificial plastic bone implanted.
Since then, he has repeatedly suffered from cellulitis! Yesterday, my father felt chills and discomfort, so I called an ambulance to take him to the emergency room.
It turned out that there was a lump on his left thigh, and there were two red spots on his calf!? The major car accident occurred in 1981.
I understand that this inquiry cannot replace an actual consultation, and I do not doubt the expertise of the attending physician; I am just really anxious! Since being admitted to the hospital, my father has been running a fever, initially reaching 40.1 degrees Celsius, then dropping to 38 degrees, but his temperature has been fluctuating around 38 degrees.
I am very worried that his brain might be affected by the fever! The hospital has only administered antibiotics and antipyretics, and provided ice packs, but I feel like it’s not effective! If the cause cannot be identified, this situation will continue.
My mother passed away from cancer in 2007, and I am very afraid that something might happen to my father! I truly want my father to live a few more years; he is currently 69 years old, and I know that it won’t be long before we might have to say goodbye.
What should I do? Thank you.

Jason, 30~39 year old female. Ask Date: 2020/03/04

Dr. Chen Bozhang reply Family Medicine

If there is a persistent elevated body temperature, it is recommended to consult an infectious disease specialist to determine if there is an infection issue.

Reply Date: 2020/03/04

More Info

Managing complications after major surgery in elderly patients is a critical concern, especially given the unique challenges this demographic faces. Your father's situation, involving a history of significant trauma and recurrent infections, highlights the complexities of post-operative care in older adults.

Firstly, it’s essential to understand that elderly patients often have multiple comorbidities, which can complicate recovery from surgery. Age-related physiological changes, such as decreased immune response and slower healing processes, can increase the risk of complications like infections, delayed recovery, and even respiratory issues. In your father's case, the presence of cellulitis (the red, swollen areas you described) and fever indicates a potential infection that needs to be addressed promptly.

The fever your father is experiencing, especially with temperatures reaching as high as 40.1 degrees Celsius, is concerning. It could be a sign of an underlying infection, possibly related to the surgical site or systemic infection. The fact that he has a history of recurrent cellulitis suggests that he may be more susceptible to infections, which can be exacerbated by his previous surgeries and the presence of foreign materials (like the artificial bone) in his body.
Antibiotic therapy is crucial in managing infections, and it’s important that the healthcare team is monitoring your father’s response to treatment. If his fever persists or worsens, further investigations may be necessary, including blood cultures, imaging studies, or even a reassessment of the surgical site to rule out abscess formation or other complications.
In addition to infection management, it’s vital to ensure that your father is receiving adequate supportive care. This includes hydration, nutrition, and pain management, all of which can significantly impact recovery. If he is unable to eat or drink adequately due to nausea or discomfort, this could further complicate his recovery. It may be beneficial to discuss with the medical team about potential interventions to manage these symptoms, such as anti-nausea medications or adjustments in his diet.

Moreover, the psychological aspect of recovery in elderly patients should not be overlooked. Anxiety about health, fear of dying, and the stress of hospitalization can affect recovery. Providing emotional support and ensuring that your father feels comfortable and informed about his care can help alleviate some of these concerns.

Given your father's age and medical history, it is also essential to have a multidisciplinary approach to his care. This may involve collaboration between surgeons, infectious disease specialists, geriatricians, and nursing staff to ensure comprehensive management of his condition.
If you feel that your father's care is not meeting his needs or if you have concerns about the treatment plan, do not hesitate to advocate for him. Asking for a second opinion or requesting a care conference with the medical team can provide additional insights and reassurance.

In summary, managing complications after major surgery in elderly patients requires a thorough understanding of their unique needs. Continuous monitoring for signs of infection, ensuring supportive care, and addressing both physical and emotional health are crucial components of recovery. Your proactive approach in seeking information and advocating for your father’s health is commendable, and it’s important to maintain open communication with the healthcare team to ensure the best possible outcomes.

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