Perioperative Care, Complications, and Patient Safety
Core concepts
Understand risk stratification and perioperative optimization: VTE prophylaxis, glycemic control, nutrition, smoking cessation, and anticoagulation management. Know airway considerations in head and neck surgery (tracheostomy indications, difficult airway, postoperative edema) and free flap physiology (avoid vasopressors when possible, maintain perfusion, temperature, and hematocrit). Recognize complications: hematoma, seroma, infection, fistula, flap failure, nerve injury, and CSF leak. Know patient safety principles: wrong-site surgery, retained foreign bodies, communication, and closed-loop handoffs. Understand informed consent and documentation, and the role of morbidity and mortality review.
Traps
Questions test early recognition of hematoma causing airway compromise-evacuate, do not just observe. Another trap is overaggressive fluid or vasopressor use in free flap patients. Know that postoperative fever has a differential (atelectasis, UTI, wound, line) and that timing matters. Also know tracheostomy indications and that a patient with a fresh flap and neck swelling may need emergent airway control.
Worked example / rule of thumb
A patient with a free flap becomes tachycardic with a tense neck and falling oxygen saturation: open the wound, evacuate hematoma, secure airway. Rule of thumb: airway first in neck hematoma; optimize perfusion and avoid unnecessary vasopressors in free flaps.