MAY 2025
Avoidable mortality from postoperative bowel perforation and pulmonary aspiration has been identified in patients undergoing non-gastrointestinal surgery, particularly after orthopaedic and spinal surgery.
In such cases there has been failure to diagnose or adequately manage severe constipation, failure to adequately examine and investigate the post-operative patient complaining of abdominal pain and failure to understand the practical importance of monitoring bowel function postoperatively including the use of bowel charts.
Identified risks include elderly patients with pre-existing bowel motility issues, patients on prolonged opioid therapy postoperatively, failure of adequate communication of basic physiological functions when patients are transferred between facilities/units and patients on medical wards.
Recommendations include:
- Adequate examination of patients complaining of unexpected post-surgical abdominal pain including, where indicated, digital rectal examination. Early investigation as required.
- Education of medical and nursing staff on the importance of aligning observed bowel function with recorded observations including bowel charts.
- Education of medical and nursing staff as to the risks of severe constipation in the postoperative period including bowel perforation and pulmonary aspiration.
- Patient education as to expectations of bowel function postoperatively and the importance of “speaking up” or seeking assistance when normal bowel habit has not returned after surgery.