Health Matters

Are you having a body part removed or altered in the near future? Here is a brief, pre-surgical primer to help you. All surgeries have some risk, but the degree really depends on two things: the severity of the surgery and the condition of the patient at the moment before the knife is drawn across the skin. Low risk patients are young people who have no medical problems. Low risk surgeries are those that do not involve expeditions into a major body cavity. The very highest risk is a combination of an emergency surgery involving a major giblet on an older person with multiple, unstable, medical illnesses. Happily even high risk patients can be made to be safer if there is time before the surgery.

Even in the best situations there are some unknowns and surprises, such as adverse reactions to medications, excessive bleeding, unusual anatomy, the patient catching fire, etc. Also know that not all surgeries are equal. The average time for a particular surgery might be exceeded. Let’s say your surgeon doses off – the longer the surgery, the higher the risk. This is why there are known and accepted complication rates to all procedures in medicine. My goal, as a general physician, is to prepare a patient as well as possible before a surgery to help keep those rates as low as possible.

Other than cutting a hole into your body, why is surgery so hard on you? The answer is complicated. Repairing the damage requires a lot of energy. This is why people can feel fatigued long after the surgery. It is also why laparoscopic surgery has become so popular, smaller hole, less damage, easier recovery. The hole also creates an opportunity for bacteria to enter, so infections can happen. Unless you are a deep sea sponge, blood loss always follows the making of a hole. That blood must be replaced (more energy) and if the loss is significant, then several organs are made to work harder for a while particularly the heart, lungs, and the kidneys.

If you have a weak organ, the stress of the surgery will be particularly hard on it. Some degree of failure of the heart, kidney, or lungs is not rare either during or soon after a surgery. Your doctor, your surgeon, and the anesthesiologist all need to pay special attention to the parts of you that may be weak. Yes, they will have to stay awake the entire surgery.

Another problem is that of “fluid shifts,” which means that some parts of you may retain too much fluid. This means lots of extra work for the heart and the kidneys. If the fluid ends up in the lungs, it can be especially dangerous. Another common problem associated with surgery is abnormal clotting. Deep venous thrombosis “DVT” and pulmonary embolism “PE” are clots in the legs and the lungs respectively. They are probably caused by a combination of injury to vessels, the fluid shifts mentioned, and prolonged immobility. All major surgeries pose these dangers, although orthopedic surgeries, for example a hip or knee replacement, are the worst for this.

To lower your risk, stop smoking. In the case of bone surgery, the surgeon won’t even consider it until you have stopped. Make sure that any medical conditions you have are tuned up. Do not eat before surgery. Barfing is considered bad form by most anesthesiologists. Be physically fit. You may not be able to exercise prior to a surgery, but if you can it is helpful. Give your doctor the most complete medical history that you have. The details may be very important. Showing up on time is nice too.