Understanding the Risks Involved When Having Surgery

No Surgery Is Risk Free, But What Are the Risks?

Anesthetist in an operating room
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Understanding the Risks of Surgery

If you are planning to have surgery your biggest concern should be the final outcome. Are you a high-risk surgical candidate or a low-risk candidate? Will your life be improved by the procedure or do the risks outweigh the rewards? No surgery is risk-free, but understanding the possible complications can help you make a better decision.

Immediately before your surgery the surgeon will meet with you and explain the potential risks for your surgery.

This process is called "informed consent" and is necessary, but often happens too late to assist in planning.

A discussion of risks should take place well before the day of surgery. One of the best ways to lower risk is to choose a surgeon who performs the procedure regularly in a facility that is familiar with both the surgeon and the surgery.  You should also be prepared to ask questions during your office visit before surgery.

Common Surgical Risks:

Anesthesia Complications During Surgery

Most problems that arise during surgery are the result of the surgery, not the sedation for the procedure. While uncommon, there are very serious complications that can occur if a patient has a reaction to the anesthesia drugs.

Most problems associated with anesthesia are related to the process of intubation, or inserting the breathing tube. Aspiration, or breathing food or fluid into the lungs, can be a problem, during surgery.

Some patients also experience an increased heart rate or elevated blood pressure during the process.

The problem of anesthesia awareness has been discussed a great deal in the media, but waking during surgery or being awake throughout the surgery, is a very rare when anesthesia is provided by an anesthesiologist or a certified registered nurse anesthetist (CRNA).

Malignant hyperthermia, a reaction to anesthesia that causes the patient’s temperature to rise rapidly, is life threatening. A patient who has had malignant hyperthermia in the past has a significantly increased risk and should discuss the issue with their surgeon and anesthesia provider.

Bleeding Problems During Surgery

Some bleeding is expected during surgery, but bleeding beyond the normal amount can make a transfusion necessary. If bleeding is severe enough to cause a crisis, surgery may be terminated or a significant transfusion may be necessary.

Some religions forbid transfusions, an issue that must be discussed with the surgeon prior to scheduling a procedure. Bloodless surgery, which means having a surgical procedure without administering blood products, is becoming more common every year.

Blood Clots Caused by Surgery

Blood clots, often referred to as a deep vein thrombosis (DVT) are a significant risk of surgery. The clots can start in the area of surgery or be caused by inactivity during recovery.

Most post-operative patients are given medications, such as heparin, to “thin the blood” to help prevent the formation of clots. A clot(s) can become a critical complication if they begin to travel through the bloodstream and lodge in the lung, a condition referred to as a pulmonary embolus, or to the brain, causing a stroke or “brain attack”.

Patients with a previous DVT are at greater risk for additional clots and should make their surgeon aware of this condition.

Death Due to Surgery

All surgeries, whether elective or necessary, carry a risk of death. A surgery that requires stopping the heart will have a higher risk than a surgery to remove tonsils, but both can still result in death.

Trauma surgery, an emergency surgery to save the life of an injured patient who will die without an intervention, is an example of a very high-risk surgery. In this case, the possibility of survival after surgery contrasts with the certainty of death without.

When considering a non-essential procedure, such as plastic surgery, the seriousness of surgery should be considered when deciding on the procedure.

Delayed Healing After Surgery

Some patients take longer to heal than others, particularly people with more than one illness. A patient with a chronic illness, an immune system problem, or sickness in the weeks prior to surgery may have a lengthier hospital stay and a more difficult recovery period.

Diabetics who have surgery typically have a longer healing time, especially if blood sugar levels are poorly controlled. For this reason, diabetics must carefully weigh the risks and rewards of having surgery, including the potential complications during recovery.

Difficulty Breathing After Surgery

Most patients can be removed from the breathing machine, or ventilator, at the end of surgery. Some patients can require the ventilator longer. In extreme cases, patients must be transferred to a rehabilitation facility for the purpose strengthening their breathing until they are able to be removed from the ventilator completely.

Patients most at risk for remaining on the ventilator are those with pulmonary diseases, smokers, patients who are chronically ill and patients who required ventilator support prior to surgery.

Infections After Surgery

There is a risk of infection any time the skin, a natural barrier to infection, is opened. A surgical incision creates a significant opportunity for infection to enter the body, even though surgery is done in a very clean environment.

A patient with an infection that creates the need for surgery is at a greater risk for an infected incision or a blood infection and should be able to identify the signs and symptoms of a worsening infection.

Most patients will receive antibiotics before and after surgery to reduce the risk of infection. Medical staff will also use special precautions when changing dressings to help prevent infections.

More About The Risks of Surgery

Injury During Surgery

When having surgery there is the risk that parts of the body will be damaged in the process. For example, a patient having surgery to remove their appendix may have an accidental injury to the intestine, which is attached to the appendix.

This sort of injury may be detected during the procedure and fixed immediately or may become an issue during recovery when medical staff detects the problem.

If the injury is severe enough, additional surgery may be required.

Paralysis Caused by Surgery

One of the most severe complications, paralysis is very uncommon but can happen, particularly during brain and spinal surgery. Depending on the nature and location of the surgery, the risk of paralysis may be greater.

A surgery to remove a mass that is tangled in the spinal cord or a surgery to repair a bad disc in the spine would have a higher risk of paralysis than an abdominal surgery as the surgeon is working directly with the spinal cord.

Poor Results After Surgery

A poor surgical outcome can include severe scarring, the need for additional surgery or a procedure that does not provide the desired results. If the patient’s expectations are realistic and the results are not acceptable, there may be significant time and expense involved in fixing the problem.

In some cases, poor results cannot be prevented, especially if the problem is worse than anticipated once surgery starts or if additional problems are found once the incision is made.

Some surgeries have to be shortened if the patient is not tolerating the procedure, a decision than can affect the overall outcome.

A poor outcome that is the fault of the surgeon may be preventable if an experienced surgeon familiar with the procedure is selected. In cases where a poor outcome appears to be the fault of the surgeon a second surgeon may need to be consulted to discuss further treatment.

Numbness & Tingling After Surgery

Many patients experience numbness and tingling around their surgical site, for some it is a temporary condition; others find it to be a permanent complication. Creating an incision requires the surgeon to cut through nerves, which send messages between the body and the brain. If enough nerves are cut, the area surrounding the surgical site may have numbness or a tingling sensation.

Depending on the location of the damage, the nerve may regenerate, allowing sensation to return to the area over the course of weeks or months. In other cases, damage to the nerves may be too great for the body to repair, resulting in permanent numbness or tingling.

Scarring After Surgery

Scarring after surgery is not always preventable, especially when a large incision or multiple incisions must be made. All patients with an incision risk scarring. In elective surgery such as plastic surgery, an obvious scar can be a much larger issue as the surgery is typically done in a place that is visible to others.

Patients have a significant responsibility for the prevention of scarring. Following instructions from the surgeon is essential. Instructions frequently include very specific methods of wound care and smoking cessation before and continuing after surgery.

Plastic surgeons typically require their patients to quit smoking at least two weeks prior to surgery because studies have repeatedly shown that smokers have scarring that is significantly worse after surgery. If a patient chooses not to quit smoking and scarring results, the physician has no control over this outcome.

Choosing an excellent surgeon and following instructions can help to ensure minimal scarring. In cases of scarring that is a result of poor surgical skill, an additional surgeon may be required to repair the resulting damage.

Swelling and Bruising After Surgery

Surgical site bruising and swelling are considered normal parts of the healing process after surgery. The severity can be influenced by many factors including the type of surgery, the amount of force required to complete the surgery, the complexion of the patient and the type of care given after surgery.

Cold compresses and other simple remedies may speed the healing process while the use of certain types of medications can make bruising worse. These concerns should be discussed with the physician.

For most procedures, the surgeon should be able to give a general estimate for when bruising and swelling should completely subside.

References:

Patient Information Pamphlet, American College of Surgeons, 2007

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