July 14, 2026 | Recovery
A patient asked me a question last month that I have been mulling over ever since. She was two days out from surgery, feeling perfectly fine, and she asked, “How will I know if something is wrong? Like, actually wrong.”
It is a valid question that most of us answer badly. Here is a list of terrible symptoms, please go home and wait for something horrible to happen. She would be waiting a long time. The nasty infections rarely announce themselves with their late and dramatic warnings.
MDLinx interviewed me recently for an article on infection after surgery, and the line they chose to lead with is the one I want every patient to hear. It is the boring, early warning signs, the ones easily ignored and reasoned away as something less concerning, that we most need to be vigilant about.
The Classic Signs Are Usually the Late Ones
Clinicians are trained to think about a specific set of findings as markers of significant infection. A blood pressure that is starting to tank. A narrowing pulse pressure, meaning the gap between the top and bottom numbers of the blood pressure is creeping tighter. Skin that is cool and clammy. Lactate climbing, which is a blood test indicating that cells are not getting enough oxygen. White cell counts swinging. Creatinine escalating, another marker that the kidneys are struggling.
They are all real. They all mean a real problem.
They also all appear after the optimal window for fixing the situation has already closed, turning a solvable problem into a difficult rescue.
Far less spectacular is the early warning sign. A heart rate that has been ticking up steadily over twenty four hours. A temperature that is elevated but not quite in fever territory. Less urine than the patient is used to producing. A higher respiratory rate. Just a general feeling of foggy, off, not like yourself. After abdominal surgery, pain that increases or spreads, bloating, nausea, or no passing of gas.
One single reading by itself is not all that alarming. Cumulatively and over time, it adds up to a warning.
Why the Trend Matters More Than the Number
This simple insight changed my thinking entirely, and the line MDLinx pulled captures it.
Sepsis lives in the trends.
A pulse of 104 is a number. A pulse that went from 80 in the morning, to 90 by midday, to 98 in the afternoon, to 104 by evening has a direction. The direction is where the next steps live.
It is a common error to view each single measurement in isolation, because each one can be readily explained. The patient is worried. She took a walk down the hall to the restroom. He is uncomfortable because of surgical pain. The room is warm. Every one of those explanations is perfectly reasonable and usually true. And every one of those good explanations serves to flatten an increasingly alarming trend into a series of unremarkable moments.
The situation is not much easier inside a hospital. Handoffs move from shift to shift. The nurse who was paying close attention overnight is on her way home by the time morning rounds begin. Handoff reports are generally much better at relaying task continuity than trend analysis. So a trend gets broken into disparate data points, each one seen by a different team member.
What I Do Differently After Surgery
I completed a general surgery residency at Texas Tech University Health Sciences Center, then a plastic surgery fellowship at the Mayo Clinic, and I am board certified by both the American Board of Surgery and the American Board of Plastic Surgery. Those years of general surgery training taught me this, because in general surgery infection after an operation is not an uncommon thing.
Instead of passively reviewing paperwork or test results, I want to see patients in person and early. I am interested in a patient’s trajectory, not in a single snapshot measurement.
My patients can call my office directly and they can text. I would always prefer ten calls about something that turns out to be trivial to missing the one patient who was quietly worsening and did not want to bother anyone. Nobody has ever annoyed me by contacting me. Not once.
I also ask patients a question other than the one they have become accustomed to. Not “how bad is it,” but “is this worse than it was yesterday?” Severity on a given day can be just a point in time. A change in condition over a three day interval is far more telling.
What You Should Call Us About
If you are recovering at home, here is what I would want you to call us about. None of it is dramatic, by design.
- Pain that is worsening over time, or that is moving beyond the original surgical site
- A heart rate that steadily increases over the course of a day, even if it never reaches a single worrisome number
- Any fever, or a temperature that is trending upward toward fever territory
- Confusion, unusual drowsiness, or a general sense of not feeling like yourself
- Noticeably decreased urine output
- Faster breathing, or a sense of shortness of breath
- After abdominal surgery, nausea, vomiting, bloating, or not passing gas
There is no need to be sure. My job is the diagnosis. Yours is the detection. Just let me know which way things are heading.
If you are in a hospital bed, the situation is much the same, with one addition. If you can report that “this has been worsening day after day for three days straight,” the team now has exactly the signal the system is worst at holding onto.
Why Choose Dr. Agullo
- Double board certified: American Board of Plastic Surgery and American Board of Surgery
- Fellow of the American College of Surgeons
- Plastic surgery fellowship at the Mayo Clinic
- Clinical Associate Professor of Plastic Surgery, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine
- Castle Connolly Top Doctor for thirteen consecutive years
Safety may not be the most glamorous aspect of surgery, but it is the deciding factor behind everything else.
Ready to Talk?
Planning a surgery? Ask your surgeon precisely how they will follow you afterward, who will see you, and how quickly you can reach a human being. You have a right to specific answers.
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful.
For the surgeon-facing view of how the trend gets lost in hospital handoffs, see the companion post on drworldwide.com. For how our team handles postoperative follow-up, see the version on swplasticsurgery.com.
@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
