Surgery. It’s a scary word. Especially if it is preceded by the words “you need”. No matter what type of surgery you may be considering, many concerns will arise, and you will likely fear the worst. Many of the logical issues you are concerned about include:
- Is my surgeon competent?
- Is the hospital competent?
- What if I have a heart attack?
- Stroke?
- Blood clot?
- Infection?
Those are intuitive questions and reasonable fears. Surgical complications, even with a well-executed procedure are rare, but do occur. The goal of any surgical team is to minimize the risk of surgical complications. For decades surgical complication strategies have always focused on time frame from when the knife is “dropped” until the time the patient has left the hospital.
Thankfully that purely in-hospital approach to complication prevention is changing. It turns out, that your health status BEFORE surgery has a lot to do with your risk of developing a surgical complication. This isn’t rocket science, but it is a critically important part of the overall surgical care episode. A “care episode” represents the treatments, tests, and interactions that are necessary to help you from the time you first interact with a surgeon, until you have been determined to be “recovered”. There will likely be many many physicians and other health care workers involved in the care episode as your care team. A fully functional care team must include you, the patient, a spouse, partner, friend or advocate too.
Optimizing your health before surgery should concentrate on a few key areas:
- Nutrition: If you have not been eating well, you may be malnourished, and you are at a higher risk of infection and poor wound healing.
- Blood sugar control: The management of your blood sugar, and maintaining a Hemoglobin A1c below 6 is optimal in order to minimize your risk of developing a post-surgery wound infection.
- Smoking: Smoking will dramatically decrease the blood flow to the surgery site, and significantly increase your risk of infection.
- Medications: Many of you are on a number of medications. Some of them may increase the risk of bleeding, Excessive bleeding can be very dangerous, and blood collections around surgical incisions increase the risk of an infection.
As this recent NY Times article highlights… other socio-economic factors play a role in determining your overall risk of developing a surgical complication.
The Michigan researchers reported these findings:
■ In the month after their operations, the Medicaid patients had two-thirds more complications and were more than twice as likely to die, compared with those on private insurance.
■ Medicaid patients typically needed extra time in the hospital — three days, on average, rather than two — and were more likely to return after going home from surgery.
■ Medicaid patients “had more emergency operations and used 50 percent more hospital resources than patients with other kinds of insurance.”
via Poorer Health of Surgery Patients on Medicaid May Alter Law’s Bottom Line – NYTimes.com.
Thankfully, many physicians and organizations are focusing their attention in this area. Kudos to the researchers behind Strong For Surgery. Their group is attempting to streamline the evaluation and management of patients BEFORE surgery with the aim of minimizing many potential post-surgery complications.
A mention should also go out to Dr. Jordan Schlain and his crew at HealthLoop. They are big pictures thinkers who are focusing their attention on the entire care episode around many surgical conditions as well as other chronic disease states. By educating you, engaging you and allowing you to communicate seamlessly with your care team, the HealthLoop team stands to significantly decrease the number of complications which arise, and also improve your outcome if a complication should arise, because that complication will be identified promptly.
If you are considering surgery … pay attention to your health prior to entering the hospital. It could spare you a significant amount of misery, pain, time, loss of income, etc.
Thank you for your previous answer!
I am now 6 wks post op from a Capsular release. Unfortunately, I have a small full thickness tear that hasn’t been repaired. My Surgeon thinks that it may heal on its own. I am having difficulty with reaching across my chest, pushing myself up and holding my arm level to be able to do the belly press test. What is the likeliness that this is a result of adhesive capsulitis and not the result of a Subscapularis tendon tear, even if it’s a small full thickness tear. If it’s not repaired, what does my future hold and being able to return to my physical job or working our as I previously did?
Thanks for your help!
Too early to tell.. It will take a number of months for you to recover from a capsular repair. I can’t comment on the subscapularis since I can’t see you or your studies to examine.
Howard Luks
Generally, a patient is afraid of surgery. They think of a surgeon and hospitals as competent. This post shows the things that worry the patient and shows that most problems, if they do occur, aren’t going to be from surgery. Very informative and helpful for someone worried about surgery.
Dear Dr. Luks
I’m 22 and have bad shoulder pains it all started about 4 months ago at work. I get this hard grinding in the back side of my shoulder with a loud pop that kills me when it does it and it really only happens when I lift my arms straight over my head or kinda out in front of me. They get to the point that they hurt so bad I can’t sleep for a couple days and work won’t do anything about it besides tell me to stretch it and I have tried that and it hurts even worse when I’m at work can u please help me just a little bit?? Like what can I do to take the pain down? Do need to do something that I don’t know about ?? Thank u so much
zach
Hi Zach … You need to be seen by a shoulder doc to get a diagnosis. It might be a labral tear, you could have instability — but unless you’re examined by a good doc and have a diagnosis, then treatment options aren’t reasonable to discuss yet.
Good Luck
Howard Luks
Dr. Luks,
I have been diagnosed with a “large grade to full thickness tear of the distal supraspinatus tendon measuring 1.2 cm in anterior and posterior dimensions.” The localized retraction is 0.9 cm. No muscle atrophy is noted. I don’t know how I tore it but it might have been lifting some heavy boxes.
My doctor says I need surgery now. Is it possible to avoid surgery with physical therapy? Is there a time frame in which it must be done?
Thank you very much,
Pam
Hi Pam… There are many issues to be considered. We, as a sports community favor fixing traumatic tears with a known cause. Many tears are degenerative, where the tissue simply wore out. We’re not in such a rush to fix those. A 1cm tear is not very large. Right now you have very little retraction and no atrophy. That can change if the tear becomes larger. Some tears do become larger, and yet some do not. It is not always an easy decision to determine who needs a cuff repair and who doesn’t. What we do know is that those who choose non-surgical care – PT, etc should be re-evaluated every so often to be sure that the tear is not getting larger.
Good Luck..