Understanding the Risks of Surgery
If you are planning to have surgery your biggest concern should be the final outcome. 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 absolutely necessary, but 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.
Common Surgical Risks:
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 significant increase in 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 the administration of 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 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.
All surgeries, whether elective or absolutely 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 safe 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 making the decision to 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 much 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.
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 who has an infection that creates the need for surgery is at a greater risk for an infected incision or a blood infection.