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?
- Blood clot?
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.”
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.