Despite major advancements in surgery and anesthesia, the risk of mortality following cardiac and non-cardiac surgery remains high and is frequently associated with perioperative organ dysfunction. Neurological derangements range from brief postoperative delirium to postoperative cognitive dysfunction to perioperative stroke with associated impact on quality of life and mortality. Major adverse cardiac events and arrhythmias play a significant role in adverse clinical outcomes following all surgical procedures. GI dysfunction represents one of the more common complications following surgery, while hepatic dysfunction remains infrequent but largely uninvestigated. Perioperative endocrine dysfunction consists of both hyperglycemia and hypoglycemia, both of which can have significant effects on perioperative course and recovery. Postoperative pulmonary complications remain one of the more common perioperative complications depending on patient-related and surgical factors. Perioperative acute kidney injury is common in the perioperative setting. This chapter briefly explores the impact of cardiac and non-cardiac surgery on individual organ systems and some of the effects of these perturbations on perioperative morbidity and mortality.

A 64-year-old woman, gravida 2, para 2, underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy due to symptomatic uterine fibroids. Intraoperative findings were notable for significant adhesive disease involving loops of small bowel to the anterior abdominal wall from a prior ventral hernia repair with mesh. Adhesiolysis took 1 hour. Postoperative days 1 and 2 were uneventful except for minimal oral intake with progressive abdominal distension. On the morning of postoperative day 3, she complained of nausea and abdominal distension. She reported worsening dyspepsia, minimal appetite, and no flatus or bowel movement since surgery. Her pain remained well controlled on oral pain medication. She was ambulating without difficulty.

Key Learning Points

1. 1. Ileus is the absence of bowel motility and is common in intensive care patients.

2. 2. Ensure early surgical input to all cases of mechanical bowel obstruction.

3. 3. In adults, large bowel obstruction is most commonly caused by cancer.

4. 4. Resuscitation and correction of electrolyte disturbance are required in all cases.

5. 5. Untreated bowel obstruction leads to dilation and increases the risks of perforation and ischaemia.