Complication (medicine)

Last updated October 21, 2024

A complication in medicine, or medical complication, is an unfavorable result of a disease, health condition, or treatment. Complications may adversely affect the prognosis, or outcome, of a disease. Complications generally involve a worsening in the severity of the disease or the development of new signs, symptoms, or pathological changes that may become widespread throughout the body and affect other organ systems. Thus, complications may lead to the development of new diseases resulting from previously existing diseases. Complications may also arise as a result of various treatments.

The development of complications depends on a number of factors, including the degree of vulnerability, susceptibility, age, health status, and immune system condition. Knowledge of the most common and severe complications of a disease, procedure, or treatment allows for prevention and preparation for treatment if they should occur.

Complications are not to be confused with sequelae, which are residual effects that occur after the acute (initial, most severe)^[1] phase of an illness or injury. Sequelae can appear early in the development of disease or weeks to months later and are a result of the initial injury or illness. For example, a scar resulting from a burn or dysphagia resulting from a stroke would be considered sequelae.^[2] In addition, complications should not be confused with comorbidities, which are diseases that occur concurrently but have no causative association. Complications are similar to adverse effects, but the latter term is typically used in pharmacological contexts or when the negative consequence is expected or common.

Common illnesses and complications

Iatrogenic complications

Medical errors can fall into various categories listed below:^[3]

Medication: Medication medical errors include wrong prescription, impaired delivery, or improper adherence. The process of prescribing medication is a complex process that relies on the accurate transfer of information through various parties. Prevention methods include increased use of electronic prescription, pre-packaging unit dosing, and ensuring medical literacy among patients.
Surgical: Surgery-related medical errors can be anesthesia-related, but most often include wrong-site and wrong-patient procedural errors. Preventive measures include following and double-checking standardized surgical protocol before, during, and after procedures. Universal surgical protocols include verification of patient identity and proper site-marking.
Diagnostic: Diagnostic errors include misdiagnosis, wrong diagnosis, and over diagnosis. Diagnostic errors are often the result of patient characteristics and physician bias.
Machine interface: Errors in this category refer to mistakes in human interaction with tools or machines. Machine-related errors can be reduced by standardization and clear differentiation in design of products.
Transition and handoff: Errors in this category can occur person-to-person or site-to-site during transfer, and can be managed by adhering to proper hand-off protocols.
Human factors, teamwork, and communication: Errors in this category highlight the impact of culture and relationships on communication. These concepts can play a role in other categories of medical errors. Preventive measures include cultivating a "culture of safety" which includes creating an environment where people feel comfortable discussing concerns, feedback, and errors without fear of punishment.

Image of a urinary catheter, a common cause of healthcare-associated infections.
Healthcare-associated infections (HAIs): HAIs are complications of general treatments involving microorganisms or viral infections and are most commonly caused by indwelling devices (urinary catheters, central lines) or previous surgical procedures.^[4] Common microbes involved in HAIs are Escherichia coli, Proteus mirabilis,^[5] and Clostridioides difficile .^[4] The most effective preventive measure is hand-hygiene.^[6]

Cardiovascular complications

Atrial fibrillation

Atrial fibrillation is a type of arrhythmia characterized by rapid and irregular heart rhythms due to irregular atrial activation by the atrioventricular (AV) node.^[7] In the pathogenesis of atrial fibrillation, there is no effective pumping of blood into either the pulmonary or systemic circulation from the left ventricle of the heart. The left and right ventricles (lower chambers of the heart) do not fill properly due to the irregular contraction of the left and right atria (upper chambers of the heart).^[7]

A patient with atrial fibrillation may experience symptoms of fatigue, dizziness or lightheadedness, heart palpitations, chest pain, and shortness of breath.^[7]^[8] The heart does not effectively pump blood into the pulmonary or systemic vasculature, and causes the blood to remain within the chambers of the heart.^[8]^[9] The collection of blood within the heart due to atrial fibrillation can cause and increase the risk of development of a thrombus (blood clot).^[9] The thrombus can also develop into an embolus (mobile blood clot) and travel into the systemic circulation.^[9] Atrial fibrillation is associated with an increase in risk of having a stroke especially if the embolus travels to the brain.^[9]

Other examples

Thrombosis in the heart or brain, causing stroke or acute myocardial infarction can be complications of blood coagulation disorders, phlebitis ^[10] (inflammation of the veins), endocarditis ^[11] and artificial heart valves.^[12]

Metabolic complications

Diabetes mellitus

Diabetes mellitus, also known simply as diabetes, is a disorder of the regulation of blood glucose (a common type of sugar) levels. There are two types of chronic diabetes mellitus: type I and type II. Both lead to abnormally high levels of blood glucose as the body is not able to properly absorb the sugar into tissues. Diabetes requires a life-long consistent monitoring of food intake, blood sugar levels, and physical activity. Diabetes mellitus may present a series of complications in an advanced or more severe stage, such as:

Cardiovascular disease. Adults with diabetes are significantly more likely to die from heart disease than are those without diabetes.^[13] Diabetes is associated with risk factors for various cardiovascular diseases including obesity, insulin resistance, high blood cholesterol and triglyceride content, and high blood pressure. These conditions increase risk of thrombosis, atherosclerosis (blockage of coronary arteries leading to inadequate supply of oxygen to parts of the heart), and hypertension^[13] which can lead to myocardial infarction, coronary artery disease (CAD), and others.
Diabetic neuropathy. Hyperglycemia can eventually cause damage to nerves in the distal extremities (peripheral neuropathy), thighs and hips (radiculoplexus neuropathy), face (mononeuropathy), and internal organs (autonomic neuropathy).^[14] Initial symptoms may present as numbness, tingling, pain, muscular weakness, loss of reflexes or proper bodily functions, and many others.^[14]
Diabetic nephropathy. Excessive amounts of certain solutes passing through the kidneys for prolonged periods of time can lead to kidney damage.^[15] Diabetic nephropathy is specifically characterized by abnormally high levels of urinary albumin excretion. This affects approximately 40% of patients with type I or type II diabetes.^[16]
Diabetic retinopathy. Chronic or prolonged type I and type II diabetes can lead to damage in the blood vessels of the retina due to hyperglycemia (excessive blood glucose). Damage and blockage of the vessels causes microaneurysms, tears, and leakage of fluid into the back of the eye. This can eventually lead to abnormal blood vessel growth, nerve damage, or excessive pressure buildup in the eye. Symptoms initially present as blurred vision but can lead to more serious complications such as blindness, glaucoma, retinal detachment, and vitreous hemorrhage.^[17]
Foot damage. Diabetes mellitus can lead to poor vascular blood flow to the extremities. Injury of the foot with inadequate blood flow can progress to ulcers and become infected. Individuals with diabetic neuropathy may not notice the damage^[18] and may develop gangrene ^[19] (tissue necrosis due to inadequate blood supply).

Commonly referred to as "diabetic foot," wounds and ulcers are a common complication of elevated blood sugar levels in diabetes.
Skin conditions.^[20] Insulin insensitivity in the case of type II diabetes can cause prolonged increases in blood insulin. Insulin normally binds to insulin receptors but in excess amounts may bind to insulin-like growth factor (IGF) receptors in epithelial tissue. This can cause excessive proliferation of keratinocytes and fibroblasts.^[21] This presents as acanthosis nigricans, a thickening and darkening of areas of the skin such as the armpits, necks, hands, and face.^[22] Other skin conditions include diabetic dermopathy, digital sclerosis, eruptive xanthomatosis, and others.

Neurologic / psychiatric complications

Hepatic encephalopathy is a possible complication of liver cirrhosis.^[23]
Significant intellectual, physical, and developmental disability are common complications of untreated hydrocephalus.^[24]
Suicide is a common complication of many disorders and conditions that consistently affect a person's life negatively, such as major depressive disorder,^[25] posttraumatic stress disorder,^[26] schizophrenia,^[27] anxiety disorders,^[28] or substance abuse.
Complications of outpatient drugs are very common and many patients experience worry or discomfort due to them.^[29]
Paradoxical reaction to a drug; that is, a reaction that is the opposite to the intended purpose of the drug. An example is benzodiazepines, a class of psychoactive drugs considered minor tranquilizers with varying hypnotic, sedative, anxiolytic, anticonvulsant, and muscle relaxant effects; paradoxically they may also create hyperactivity, anxiety, convulsions etc. in susceptible individuals.^[30]

Reproductive complications

Pregnancy

Pregnancy is the development of an embryo or fetus inside the womb of a female for the rough duration of 9 months or 40 weeks from the last menstrual period until birth.^[31] It is divided into three trimesters, each lasting for about 3 months. The first trimester is when the developing embryo becomes a fetus, organs start to develop, limbs grow, and facial features appear.^[32] The 2nd and 3rd trimesters are marked by a significant amount of growth and functional development of the body.^[31] During this time, the woman's body undergoes a series of changes and many complications may arise involving either the fetus, the mother, or both.^[33]

Hypertension. The developing fetus enlarges in the mother's womb, placing pressure on the arteries and vasculature of the mother. This causes a reduction in blood flow and a systemic increase in blood pressure. If the mother had high blood pressure prior to and after pregnancy it is considered chronic hypertension; if it occurs after 20 weeks of gestation or pregnancy, it is gestational hypertension. A previously hypertensive mother who shows signs of gestational hypertension can lead to preeclampsia, a more severe case which can be detrimental to the mother and developing fetus.^[34]
Gestational diabetes. Appropriate levels of blood sugar is typically maintained by insulin secretion from the pancreas.^[35] During pregnancy the placenta surrounding the developing fetus produces hormones that can inhibit the action of insulin, preventing the mother's blood sugar from decreasing. Occurs primarily in the second half of pregnancy and can cause excessive birth weight, preterm delivery, and place the child at greater risk for type II diabetes.^[36]
Preterm labor. Delivery of the baby prior to 37 weeks of pregnancy is considered preterm.^[37] This can cause a variety of issues with the child including underdeveloped viscera (organs), behavioral or learning disabilities, low birth weight, and respiratory issues.^[38]
Miscarriage. The loss of the developing fetus prior to 20 weeks of pregnancy.^[37] Common causes may be related to chromosomal abnormalities (abnormal genetic makeup) of the fetus but can also include ectopic pregnancy, maternal age, and other factors.^[39]
Stillbirth. The loss of the developing fetus after 20 weeks of pregnancy. Can be due to a variety of reasons including chromosomal abnormalities, developmental issues, or health-related problems of the mother.^[37]
Hyperemesis gravidarum.^[40] Persistent, acute nausea throughout pregnancy that does not go away after the first trimester. Different from morning sickness which is more common and less severe.^[41]

Respiratory complications

Streptococcal pharyngitis

Streptococcal pharyngitis, also known as strep throat, is an infection of the respiratory tract caused by group A Strep, Streptococcus pyogenes , a gram-positive, cocci, beta-hemolytic (lyses blood cells) bacteria.^[42] It is primarily spread by direct contact and the transfer of fluids via oral or other secretions and manifests largely in children.^[42] Common symptoms associated with streptococcal pharyngitis include sore throat, fever, white excretions at the back of the mouth, and cervical adenopathy (swollen lymph nodes underneath the chin and around the neck area).^[43] Streptococcal pharyngitis can lead to various complications^[44] and recurrent infection can increase the likelihood. In many of these, lack of treatment^[45] and the body's immune response is responsible for the additional adverse reactions.^[46] These include:^[44]

Scarlet fever.^[47] In addition to the symptoms of strep throat, individuals may experience increased a red rash, increased red tone, and strawberry tongue.^[47] The prominent rash generally fades after a few days and may peel for a few weeks.^[48] Treatment is the same as for strep throat.^[49]
Rheumatic fever. Rheumatic fever generally develops a few weeks after symptoms of strep throat have passed and is less likely to develop if prompt treatment (antibiotics) is given.^[45] Typical symptoms can include polyarthritis (temporary joint pain in multiple areas), carditis or chest pain, rash, subcutaneous nodules, and involuntary jerks. Rheumatic fever is believed to be the result of an autoimmune reaction to various tissues in the body that are similar to toxins produced by Streptococcus pyogenes. Rheumatic fever may lead to more serious complications of the heart such as rheumatic heart disease. ^[50]
Glomerulonephritis. Onset of kidney damage that may present a few weeks after strep infection. Rather than being a direct result of infection in the kidneys, It is believed to be caused by an overreactive immune response. Symptoms can include blood or protein in the urine, hypertension, and reduced urine output. Can lead to further kidney damage later in life^[51]
Otitis media. Infection of the middle ear.^[52]
Meningitis. Infection of the meninges of the central nervous system (brain and spinal cord) that leads to swelling. Symptoms vary and differ between adults and children but can include headaches, fever, stiff neck, and other neurological-related issues. Early treatment is important to prevent more serious complications.^[53]
Toxic shock syndrome. A severe reaction of the body to toxins produced by various bacteria such as Streptococcus pyogenes.^[54] Results from an overactive response by the immune system and can cause hypotension, fever, and in more severe cases, organ failure.^[55]

Surgical / procedural complications

Puerperal fever was a common complication of childbirth, contributing to the high mortality of mothers before the advent of antisepsis and antibiotics.^[56]
Erectile dysfunction and urinary incontinence which may follow prostatectomy.^[57]^[58]
Malignant hyperthermia can be a reaction to general anesthetics, as a complication in a surgery.^[59]
Fractured ribs and sternum may be a complication of cardiopulmonary resuscitation attempts.^[60]

Other examples of complications

Sepsis (infection of the blood) may occur as a complication of a bacterial, viral, or fungal infection.^[61]
Miscarriage is the most common complication of early pregnancy.^[62]
Eczema vaccinatum is a rare and severe complication of smallpox vaccination ^[63] in people with eczema.

Related Research Articles

Cardiology is the study of the heart. Cardiology is a branch of medicine that deals with disorders of the heart and the cardiovascular system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease, and electrophysiology. Physicians who specialize in this field of medicine are called cardiologists, a sub-specialty of internal medicine. Pediatric cardiologists are pediatricians who specialize in cardiology. Physicians who specialize in cardiac surgery are called cardiothoracic surgeons or cardiac surgeons, a specialty of general surgery.

Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgical field.

The following is a glossary of diabetes which explains terms connected with diabetes.

<span class="mw-page-title-main">Diabetic ketoacidosis</span> Medical condition

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of consciousness. A person's breath may develop a specific "fruity" smell. The onset of symptoms is usually rapid. People without a previous diagnosis of diabetes may develop DKA as the first obvious symptom.

<span class="mw-page-title-main">Hyperglycemia</span> Too much blood sugar, usually because of diabetes

Hyperglycemia or hyperglycaemia is a condition in which an excessive amount of glucose (glucotoxicity) circulates in the blood plasma. This is generally a blood sugar level higher than 11.1 mmol/L (200 mg/dL), but symptoms may not start to become noticeable until even higher values such as 13.9–16.7 mmol/L (~250–300 mg/dL). A subject with a consistent fasting blood glucose range between ~5.6 and ~7 mmol/L is considered slightly hyperglycemic, and above 7 mmol/L is generally held to have diabetes. For diabetics, glucose levels that are considered to be too hyperglycemic can vary from person to person, mainly due to the person's renal threshold of glucose and overall glucose tolerance. On average, however, chronic levels above 10–12 mmol/L (180–216 mg/dL) can produce noticeable organ damage over time.

Streptococcal pharyngitis, also known as streptococcal sore throat, is pharyngitis caused by Streptococcus pyogenes, a gram-positive, group A streptococcus. Common symptoms include fever, sore throat, red tonsils, and enlarged lymph nodes in the front of the neck. A headache and nausea or vomiting may also occur. Some develop a sandpaper-like rash which is known as scarlet fever. Symptoms typically begin one to three days after exposure and last seven to ten days.

Fifth disease, also known as erythema infectiosum and slapped cheek syndrome, is a common and contagious disease caused by infection with parvovirus B19. This virus was discovered in 1975 and can cause other diseases besides fifth disease. Fifth disease typically presents as a rash and is most common in children. While parvovirus B19 can affect people of all ages, only two out of ten individuals will present with symptoms.

Mitral stenosis is a valvular heart disease characterized by the narrowing of the opening of the mitral valve of the heart. It is almost always caused by rheumatic valvular heart disease. Normally, the mitral valve is about 5 cm² during diastole. Any decrease in area below 2 cm² causes mitral stenosis. Early diagnosis of mitral stenosis in pregnancy is very important as the heart cannot tolerate increased cardiac output demand as in the case of exercise and pregnancy. Atrial fibrillation is a common complication of resulting left atrial enlargement, which can lead to systemic thromboembolic complications such as stroke.

<span class="mw-page-title-main">Catheter ablation</span> Removal or termination of an electrical pathway from parts of the heart

Catheter ablation is a procedure that uses radio-frequency energy or other sources to terminate or modify a faulty electrical pathway from sections of the heart of those who are prone to developing cardiac arrhythmias such as atrial fibrillation, atrial flutter and Wolff-Parkinson-White syndrome. If not controlled, such arrhythmias increase the risk of ventricular fibrillation and sudden cardiac arrest. The ablation procedure can be classified by energy source: radiofrequency ablation and cryoablation.

<span class="mw-page-title-main">Large for gestational age</span> Medical condition

Large for gestational age (LGA) is a term used to describe infants that are born with an abnormally high weight, specifically in the 90th percentile or above, compared to other babies of the same developmental age. Macrosomia is a similar term that describes excessive birth weight, but refers to an absolute measurement, regardless of gestational age. Typically the threshold for diagnosing macrosomia is a body weight between 4,000 and 4,500 grams, or more, measured at birth, but there are difficulties reaching a universal agreement of this definition.

Complications of pregnancy are health problems that are related to, or arise during pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal disorders. While some complications improve or are fully resolved after pregnancy, some may lead to lasting effects, morbidity, or in the most severe cases, maternal or fetal mortality.

Type 1 diabetes (T1D), formerly known as juvenile diabetes, is an autoimmune disease that occurs when pancreatic are destroyed by the body's immune system. Insulin is a hormone required by the body to store and convert blood sugar into energy. T1D results in high blood sugar levels in the body prior to treatment. Common symptoms include frequent urination, increased thirst, increased hunger, weight loss, and other complications. Additional symptoms may include blurry vision, tiredness, and slow wound healing(owing to impaired blood flow). While some cases take longer, symptoms usually appear within weeks or a few months.

<span class="mw-page-title-main">Diabetes and pregnancy</span> Effects of pre-existing diabetes upon pregnancy

For pregnant women with diabetes, some particular challenges exist for both mother and fetus. If the pregnant woman has diabetes as a pre-existing disorder, it can cause early labor, birth defects, and larger than average infants. Therefore, experts advise diabetics to maintain blood sugar level close to normal range about 3 months before planning for pregnancy.

End organ damage is severe impairment of major body organs due to systemic disease. Commonly this is referred to in diabetes, high blood pressure, or states of low blood pressure or low blood volume. This can present as a heart attack or heart failure, pulmonary edema, neurologic deficits including a stroke, or acute kidney failure.

Lutembacher's syndrome is a very rare form of congenital heart disease that affects one of the chambers of the heart as well as a valve. It is commonly known as both congenital atrial septal defect (ASD) and acquired mitral stenosis (MS). Congenital atrial septal defect refers to a hole being in the septum or wall that separates the two atria; this condition is usually seen in fetuses and infants. Mitral stenosis refers to mitral valve leaflets sticking to each other making the opening for blood to pass from the atrium to the ventricles very small. With the valve being so small, blood has difficulty passing from the left atrium into the left ventricle. Septal defects that may occur with Lutembacher's syndrome include: Ostium primum atrial septal defect or ostium secundum which is more prevalent.

Atrial fibrillation is an abnormal heart rhythm (arrhythmia) characterized by rapid and irregular beating of the atrial chambers of the heart. It often begins as short periods of abnormal beating, which become longer or continuous over time. It may also start as other forms of arrhythmia such as atrial flutter that then transform into AF.

Complications of diabetes are secondary diseases that are a result of elevated blood glucose levels that occur in diabetic patients. These complications can be divided into two types: acute and chronic. Acute complications are complications that develop rapidly and can be exemplified as diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), lactic acidosis (LA), and hypoglycemia. Chronic complications develop over time and are generally classified in two categories: microvascular and macrovascular. Microvascular complications include neuropathy, nephropathy, and retinopathy; while cardiovascular disease, stroke, and peripheral vascular disease are included in the macrovascular complications.

Dysglycemia is a general definition for any abnormalities in blood glucose levels. They include hyperglycemia, hypoglycemia, impaired glucose tolerance test, impaired fasting glucose, among others.

A high-risk pregnancy is a pregnancy where the mother or the fetus has an increased risk of adverse outcomes compared to uncomplicated pregnancies. No concrete guidelines currently exist for distinguishing “high-risk” pregnancies from “low-risk” pregnancies; however, there are certain studied conditions that have been shown to put the mother or fetus at a higher risk of poor outcomes. These conditions can be classified into three main categories: health problems in the mother that occur before she becomes pregnant, health problems in the mother that occur during pregnancy, and certain health conditions with the fetus.

Diabetes mellitus, often known simply as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body becoming unresponsive to the hormone's effects. Classic symptoms include thirst, polyuria, weight loss, and blurred vision. If left untreated, the disease can lead to various health complications, including disorders of the cardiovascular system, eye, kidney, and nerves. Diabetes accounts for approximately 4.2 million deaths every year, with an estimated 1.5 million caused by either untreated or poorly treated diabetes.

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