Blog
 » 
Best Practices
 » 
Recognize and Manage Post-Surgical Complications in Referred Patients

Recognize and Manage Post-Surgical Complications in Referred Patients

Best Practices

X min read

Owners

Learn how to recognize and manage common post-surgical complications in referred pets with clear steps for follow-up, treatment, and communication

By 

Sustainable Vet Group

Updated on

July 17, 2026

.

This article is for informational purposes only and is not a substitute for professional veterinary advice. Every case is unique, so always consult your veterinarian for guidance specific to your pet.

This content is intended for veterinary professionals for educational purposes. It does not replace clinical judgment or tailored advice. Always rely on your training, expertise, and the specific context of your patients.

Recognize and Manage Post-Surgical Complications in Referred Patients

When a patient returns from specialist surgery, the referring practice resumes responsibility for day-to-day post-operative management. This is a routine part of veterinary practice, but it carries specific demands: interpreting discharge instructions from a procedure you didn't perform, monitoring for complications that may look unfamiliar, and knowing when to escalate back to the surgical team.

Getting this right matters as much as the surgery itself.

 

What this covers: The most common post-surgical complications in referred patients, how to recognize them at follow-up visits, management approaches for each, the follow-up communication structure with the surgical team, and owner support during the recovery period.Scope: Applies to soft tissue and orthopedic post-operative patients returning to primary care after specialist referral. MPL surgery recovery is used as a reference case throughout.Clinical principle: The referring veterinarian is often the first professional contact when a complication develops. Early recognition, appropriate triage, and clear communication with the surgical team are the core competencies this role requires.

 

Key takeaways

  • The referring vet often sees complications first: owners contact their primary clinic before the specialist.
  • Read the specialist's discharge instructions before the patient returns for follow-up.
  • SSI, seroma, wound dehiscence, and persistent lameness are the most common post-surgical complications in referred orthopedic patients.
  • Clear discharge presents normally in the first 48 hours; purulent or foul-smelling discharge warrants culture.
  • Contact the surgical team for any major complication; don't manage implant or bone healing complications unilaterally.
  • Owner communication within 24 to 48 hours of discharge improves compliance and early complication detection.

Your role as the referring veterinarian

The post-operative period is a shared responsibility. The specialist performed the procedure and wrote the discharge instructions. The referring vet and the owner implement them.

In practice, this means:

  • Providing follow-up examinations at the intervals specified in the discharge summary
  • Managing medications, dressing changes, and rehabilitation oversight locally
  • Triaging complications and determining which require specialist re-evaluation
  • Serving as the first contact for owner concerns and questions between scheduled rechecks

The ACVS notes that post-operative care is "a collaborative effort between the owner, primary care veterinarian, and ACVS board-certified veterinary surgeon." Your practice's contribution to that collaboration is the continuity of monitoring that the specialist can't provide at distance.

Pre-visit preparation

Before the first post-operative recheck:

Review the surgical summary:

  • What procedure was performed, and are multiple procedures involved?
  • What implants were placed, if any?
  • What is the anticipated recovery timeline?
  • Are there specific restrictions or monitoring parameters from the surgeon?

Confirm medications:

  • What pain management was dispensed?
  • Are there antibiotics, and for how long?
  • Has the owner been administering correctly?

Prepare for the physical examination:

  • Know what the operated site is expected to look like at this stage
  • Have reference for normal post-operative appearance vs. expected complications
  • For orthopedic cases: understand what the surgical correction involved before assessing function

Most common complications in referred patients

1. Surgical site infection (SSI)

SSI is the most frequently encountered complication in referred orthopedic patients and is particularly relevant following MPL surgery, TPLO, and other implant procedures.

Clinical signs:

  • Redness extending beyond incision margins
  • Local heat and swelling worsening after post-operative day 3
  • Purulent (yellow, green, or creamy) discharge
  • Incision odor
  • Systemic signs: fever, lethargy, reduced appetite

Management:

  • Culture and sensitivity testing of wound discharge before initiating antibiotics
  • Empirical broad-spectrum antibiotics if culture results will be delayed and infection is clearly active
  • Wound care as appropriate to the degree of involvement
  • Contact the surgical team if the SSI is deep (involving fascial planes), involves implants, or is not responding to initial treatment within 48 to 72 hours

For implant-associated infection specifically, contact the surgical team promptly. Biofilm formation on implants may require implant removal, which is a specialist decision, not a primary care decision.

2. Seroma

A seroma is a sterile accumulation of serous fluid in a dead space beneath the incision. It is common after soft tissue and orthopedic surgery.

Clinical signs:

  • Soft, fluctuant swelling beneath the incision
  • Not hot or painful beyond mild pressure discomfort
  • Typically appears in the first 1 to 2 weeks post-operatively
  • No fever or systemic signs

Management:

  • Conservative management first: strict rest to reduce fluid production, compression bandaging where anatomically appropriate
  • Aspiration if the seroma is large, under significant tension, or causing discomfort; use sterile technique; ultrasound guidance if needed
  • Aspiration does not prevent recurrence; re-accumulation is common without strict rest
  • Placement of a Penrose drain only if the seroma is refractory and large; coordinate with the surgical team

When to escalate: If the seroma becomes infected (develops heat, discharge, systemic signs), or if it persists beyond 3 to 4 weeks without resolution, contact the surgical team.

3. Wound dehiscence

Wound dehiscence (partial or complete incision opening) requires prompt assessment and is sometimes a surgical emergency.

Classification:

  • Superficial dehiscence: Skin only has opened; deeper layers are intact
  • Full-thickness dehiscence: All wound layers have opened; tissue may be visible

Management:

  • Superficial dehiscence: clean the wound, assess for infection, determine whether re-closure is needed or if second-intention healing is appropriate. Contact surgical team.
  • Full-thickness dehiscence: cover exposed tissue with a clean, moist dressing immediately; contact the surgical team for guidance on re-closure approach; this may require specialist intervention
  • Tissue protruding: emergency. Cover and refer immediately.

The primary cause of dehiscence in referred patients is owner non-compliance with rest restrictions or E-collar removal. Reinforce these at every interaction.

4. Persistent lameness beyond expected timeline

For orthopedic referred patients, particularly post-MPL surgery, lameness that persists beyond the expected improvement timeline warrants investigation.

Differential diagnoses:

  • Re-luxation of the patella
  • Implant failure (pin migration, tibial tuberosity displacement)
  • Infection of the surgical site or joint
  • Concurrent cruciate ligament injury
  • Normal variance in healing pace

Approach:

  • Radiographs of the operated limb to assess implant position and bone healing
  • Orthopedic examination to assess patellar stability
  • Compare to the post-operative baseline radiographs from the surgical report
  • Contact the surgical team with your findings before making treatment decisions about the implant or bone healing

For reference on what normal MPL surgery recovery progression looks like and when lameness raises concern, see MPL surgery recovery as a reference case.

5. Post-operative pain beyond expected severity

Some patients experience more pain than anticipated. This is particularly relevant in bilateral cases or higher-grade corrections.

Assessment:

  • Pain scoring at each visit using a standardized tool (Colorado State Pain Scale or similar)
  • Distinguish surgical pain from position-related discomfort vs. complication-related pain
  • Assess gait, willingness to bear weight, posture, and facial expression

Management:

  • Step up analgesia within the discharge prescription parameters if available
  • Contact the surgical team if pain is severe, not responding to current medications, or if you need guidance on additional agents
  • NSAIDs, gabapentin, and opioid adjuncts are the most common options; the surgical team can advise on safe additions

The recheck examination for referred orthopedic patients

At each follow-up visit, perform and document:

  1. Incision assessment: Appearance, closure status, discharge presence and character
  2. Limb assessment: Weight-bearing status, gait quality, muscle mass comparison bilateral
  3. Joint assessment: Patellar stability if MPL; range of motion; joint effusion
  4. Systemic assessment: Temperature, appetite, energy level, pain score
  5. Radiographs: At intervals specified by the surgical team; essential at the 8 to 10 week bone healing recheck for orthopedic cases

Document findings in a format the surgical team can access if needed. Many specialists appreciate a brief update email following major rechecks.

For an owner-facing reference on the signs they should be monitoring at home between your visits, see general signs of complications after soft tissue surgery.

Communicating with the surgical team

Knowing when to contact the specialist rather than managing independently is one of the most important skills in referred patient care.

Contact the surgical team for:

  • Any major complication (deep infection, dehiscence, implant concern)
  • Re-luxation or suspected surgical failure
  • Pain that is not responding to standard management
  • Any question about modifying the rehabilitation protocol
  • A patient who is significantly worse than the discharge summary's expected trajectory

Manage locally without specialist consultation for:

  • Superficial incision redness that is not progressing
  • Small seromas under active rest restrictions
  • Mild, expected post-operative lameness on expected timeline
  • Medication refills within the existing prescription

A quick call or email to the specialist prevents the most common error: managing a complication beyond the scope of primary care while the problem worsens.

Owner support and communication

Owner compliance is the single most controllable variable in post-operative outcome. Your practice's communication structure directly affects compliance.

Check in within 24 to 48 hours of the patient's discharge from the specialist:A brief call or message asking how the dog is doing, whether medications are being given correctly, and whether the incision looks normal both supports the owner and catches early compliance failures.

Reinforce restrictions at every visit:Do not assume owners have retained all information from the specialist's discharge conversation. Re-explain E-collar use, activity restriction, and the specific signs to watch for at each contact.

Address financial anxiety directly:Complications can create anxiety about cost on top of the stress of a sick pet. Be clear about which complications are manageable at your practice level vs. which would require specialist re-referral, so owners can plan accordingly.

For guidance on rehabilitation protocols for referred post-surgical patients, including the phase-based exercise approach for MPL and other orthopedic patients returning to your care, see rehab protocols for referred post-surgical patients.

Frequently asked questions

The surgical team discharged the patient with only a brief summary. How do I fill the gaps?

Contact the specialist directly. A brief call clarifying the specific procedures performed, the expected recovery milestones, and any parameters that should trigger re-referral is entirely appropriate. Most specialists welcome this communication and will provide the context their written summary couldn't fully cover.

My patient has an implant issue on radiograph. Should I manage it or refer back?

Refer back. Implant adjustments, pin removal decisions, and assessment of failed fixation are specialist decisions. Your role is to identify the problem on radiograph, stabilize the patient, and coordinate with the surgical team promptly.

How soon should I see the patient after specialist surgery?

Follow the discharge instructions. For orthopedic patients, a 10 to 14 day post-operative recheck for suture removal and incision assessment is typical. Some specialists request an additional check at 4 to 6 weeks for gait assessment, and most schedule a formal radiographic recheck at 8 to 10 weeks for bone healing confirmation. Fit your visit schedule to these milestones.

The surgery happens once. The recovery happens over months, and it mostly happens at the primary clinic and at home. Referring veterinarians who take an active, structured approach to post-operative management, communicate proactively with the surgical team, and invest in owner education consistently produce better outcomes than those who take a passive "let the owner call if there's a problem" approach. The specialist finishes the surgery. You finish the recovery.

Resources

  • American College of Veterinary Surgeons. Postoperative Care After Surgery: What Animal Owners Should Expect. acvs.org
  • SustainableVet. Post-Surgical Follow-Up Guide for Referring Vets. sustainablevet.org
  • Allied Veterinary. How Specialty Vets Monitor Pets After Surgery. alliedervet.com

Get a Free Poster

Enhance your workspace with a high-quality radiographs reference poster, designed for veterinary professionals. This free physical poster will be shipped directly to you—just fill out the form to request your copy.

Things to know

Get a Free Poster for Your Clinic

Enhance your workspace with a high-quality radiographs reference poster, designed for veterinary professionals. This free physical poster will be shipped directly to you—just fill out the form to request your copy.

We'd love you to
Join Us!

Enter Your Details Below to Receive Your Information Pack

100% safe & secure. Your details are never shared or sold.

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

Taking Great TPLO Radiographs

Click Below to Watch Live Video Demos

We'll send you a Free Wall Poster with all the steps

Now that you are a pro at TPLO rads

Let's take your infection control to the next level

Watch these videos!

Step #1

Getting Ready

Ensuring a clean surgical field starts with proper skin preparation. This video demonstrates the best practices for:

  • Shaving the patient – Achieving a close, even shave while minimizing skin irritation
  • The Dirty Scrub – The initial skin prep step to remove surface debris and reduce bacterial load before the sterile scrub.

Following these techniques helps reduce infection risk and improve surgical outcomes. Watch the video to see how it’s done effectively!

Step #2

Reduce Your Risks

Many surgeons are shocked to find out that their patients are not protected from biofilms and resistant bacteria when they use saline and post-op antibiotics.

That’s Where Simini Comes In.

Why leave these risks and unmanaged?  Just apply Simini Protect Lavage for one minute. Biofilms and resistant bacteria can be removed, and you can reduce two significant sources of infection.

Step #3

Take the Course

Preventing surgical infections is critical for patient safety and successful outcomes. This course covers:

  • Aseptic techniques – Best practices to maintain a sterile field.
  • ​Skin prep & draping – Proper methods to minimize contamination.
  • ​Antibiotic stewardship – When and how to use perioperative antibiotics effectively.

Stay up to date with the latest evidence-based protocols. Click the link to start learning and earn CE credits!

Get Your
Free Poster!

Enter your information below, and we’ll ship it to you at no cost.

Do you want to customize it?

How many would you like?

About you

Shipping information

100% safe & secure. Your details are never shared or sold.

We will work on your request shortly.
Oops! Something went wrong while submitting the form.
What’s your role in animal care?

Tell us who you are so we can guide you to the most relevant information.