By Natasha Persaud
To avoid surgery complications, research your options
If your doctor has advised surgery or you're thinking about having elective surgery, you may have questions and concerns about getting good care.
The Joint Commission is a nonprofit organization dedicated to patient safety and quality standards for health-care organizations. We spoke with Joint Commission vice president and chief patient safety officer Peter Angood, M.D., who is also a surgeon, for tips on getting the best treatment.
1. Is surgery the right step for me?
To answer that question, you need to clearly understand your diagnosis first, and then why it is that surgery is being considered. Start by asking your primary-care doctor and/or a surgeon these questions:
- Is surgery the only way to treat my problem or are there nonsurgical approaches that could be tried?
- Are there different kinds of surgeries to treat my condition and, if so, how do they compare? Back pain, for example, can be treated in various ways and by different specialists, for example, a neurosurgeon or an orthopedic surgeon.
- Which surgical approaches are better for my particular condition and its severity, given my age and overall health status?
When considering surgery, it's often a good idea to get a second opinion to learn about your treatment options. In fact, many insurance companies require a second opinion before they will approve a major procedure.
2. How can I learn more about my surgical procedure?
Make an appointment well in advance of any planned surgery to consult with the surgeon who will be performing the operation. The surgeon will explain the procedure in depth, discuss your particular medical needs and answer your questions.
Before your visit, check out the website of the professional society affiliated with the surgeon's specialty for a general overview of the procedure. The American College of Surgeon's website offers a list of professional societies. You may also contact these societies directly for additional information.
3. How can I find the best surgeon for the job?
Finding the right surgeon takes the same effort as shopping for any other service, so tap several resources before you make a decision. You want to find the most experienced surgeon for your particular operation and not necessarily someone with a wide repertoire of surgical procedures.
Consult research studies on your type of surgery to find study authors who might be in clinical practice. Additionally, most health-care organizations, including hospitals and medical schools, provide a synopsis of their faculty and staff members that describes each individual's area of expertise. When choosing between two thoracic surgeons to perform lung cancer surgery, for example, a patient may be able to eliminate Dr. X if his specialty is more focused on cardiac diseases.
Try to find out the number of procedures the surgeon has performed—the more, the better. Other indicators of a surgeon's expertise are certification by the American Board of Surgery and active membership in the professional surgical society of their specialty. For example, an affiliation with the American College of Surgeons is indicated by the letters FACS after the doctor's name.
Finally, ask people you know who are familiar with the medical community for recommendations, including your primary-care physician, patients who have had your surgery, nurses and others in the medical profession. According to You: The Smart Patient by Michael F. Roizen, M.D., and Mehmet C. Oz, M.D., a layperson's medical book written in collaboration with The Joint Commission, two excellent sources are the anesthesiologist and the head nurse at the hospital unit where you expect to have surgery, who can both give you an insider's perspective.
Once you have your list of candidates, check the websites of your state government's department of health and/or medical licensing authority to learn if the surgeons you're considering are licensed and in good standing, with no patient complaints.
4. When it comes to where to have my surgery, does the hospital matter?
The hospital does matter. Big hospitals affiliated with universities are where leading-edge research is occurring, so patients may want to consider these first. The most contemporary approaches to surgery are happening there, and they typically have the most up-to-date equipment. The downside is that you may tend to feel lost: Instead of one or two dedicated doctors, you may be attended by a series of residents and students in training.
Affiliate teaching hospitals and private practice community hospitals can also be excellent places to have a procedure, so don’t automatically discount them. Ambulatory surgical centers and rural hospitals may do well with less complex procedures that are appropriate for their particular settings.
Pay a visit to qualitycheck.org, a service offered by The Joint Commission, to learn if the hospital or surgery center you are considering is accredited and what types of procedures are performed there. You can also check how the hospital is faring against certain quality standards, including accreditation and performance.
Surgeons are affiliated with particular hospitals, and often more than one, so bear that in mind as well when you’re considering having a procedure.
5. What can I do to prepare myself mentally for surgery?
Patients have different levels of curiosity about their surgeries. Not everyone wants to know all of the details, but some people do. You should learn as much about your surgery as you're comfortable with knowing.
To help reduce your stress, consider asking a family member or friend to serve as your health-care advocate—someone who will look out for your best interests while you are preoccupied with your own thoughts or concerns. Your advocate can ask questions that you may not think of, help make sure that you get the right medicines and treatments, and enforce your health-care wishes in the rare case of an emergency.
Planning ahead for your hospital and at-home care can also help you feel more at ease. This might include organizing family and friends to be available on a rotating basis to give you a hand while you're in the hospital or at home. You can also make sure that all the support services or supplies will be readily available when you arrive home. You do not want to be fussing with these details while you are not feeling your best.
If there are going to be special exercises, care practices or new patterns in your daily life as a result of the surgery, then learn about these ahead of time so that you can be prepared without surprises. For example, if you will have physical rehabilitation after surgery, take the opportunity beforehand to learn and practice the exercises, if you're able to.
6. How can I prepare myself physically before my surgery?
Talk to your doctor about how to get in the best physical shape as possible before your surgery. For example, if you have asthma, diabetes or heart problems, including high blood pressure, you'll want to get those under control before surgery. If you smoke, cut back before surgery, and if possible, quit. Smoking restricts blood flow to the heart and increases the likelihood of life-threatening heart and lung abnormalities.
To help strengthen your immune system so that you tolerate the stress of surgery better, eat especially nutritiously for several weeks before your surgery. This can be particularly important for cancer patients and other chronically ill patients who need surgery.
Ask your surgeon about the likelihood that you'll need a blood transfusion during surgery. If there's a chance that you'll need blood, ask whether you can donate your own blood beforehand. This service is now readily available in most communities. Your blood is the best blood to receive.
To reduce the chances of infection during surgery, avoid shaving the surgical site, since doing so can cause tiny skin nicks and open the skin to bacteria that can create infection. You’ll also be asked to remove all makeup, nail polish, contact lenses, false eyelashes and jewelry. Ask your surgeon’s office about all of these types of preparations.
7. How can I reduce the chances of a medical mistake?
Your medical team should follow The Joint Commission's three-step protocol to reduce the chances of a surgical error, including:
- verifying the procedure with you,
- marking the surgical site
- and taking a time-out to review the procedure with the entire medical team prior to surgery.
Expect many members of the medical team (and there may be a lot: surgical assistants, physician assistants, operating room nurses, an anesthesiologist and nurse anesthetist) to ask who you are, what surgery you're having and what part of the body is being operated on. Doctors and nurses triple-check your identity to make sure that you're the right patient before they even lift a scalpel. It's a good idea to have a family member or friend with you to answer questions and prevent oversights and mistakes, in case you're not able to do so.
If you're having an inpatient procedure and will spend part of your recovery time at the hospital, make sure that every nurse checks your identity in two different ways, by checking your wrist band information and asking for your social security number, for example, to reduce the chances of medication mishaps.
All surgery patients should receive educational material from their hospital prior to surgery stating what they're doing to prevent surgical errors.
8. What do I need to know about anesthesia?
A preoperative visit is usually scheduled with a member of the anesthesiology team who will be providing anesthesia during your surgery. This visit is to perform a focused physical assessment by the anesthesiologist and to review the options for anesthesia. Depending on the procedure, you may receive local anesthesia, which numbs just the area being treated; regional anesthesia, which numbs an entire area such as a spinal block or an extremity; or general anesthesia that causes complete sedation.
For some patients, the anesthesia administration is more important than the actual surgery in terms of having an optimal outcome. These can include patients with certain allergies, neurological conditions such as epilepsy or stroke, lung problems, immune function disorders, stomach problems or other conditions that may make complications more likely. If someone has significant lung, heart or kidney conditions, the anesthesiologist will make sure that the patient's metabolic and physiologic functions are maintained in an optimal state throughout the entire length of the surgery to minimize complications. Make sure to ask about your options for anesthesia, the pros and cons and the potential complications.
9. What about pain?
The amount of pain a person experiences will vary with the type of procedure, the anesthesia methods and his or her tolerance to pain. Your surgeon, or a medical consultant working with your surgeon, orders your pain medications.
There are several types of pain medications, such as nonsteroidal anti-inflammatory drugs, opioids, and anesthetics. It may take a few tries to find the one that works well for you. The goal is to have you comfortable but not too drowsy, so that you can participate effectively in your postoperative care.
It's the job of the nurses attending to your care to track your level of pain. Your nurse will often ask you to rate your pain on a scale from 1 to 10, with 1 indicating mild discomfort and 10 signifying severe pain. Be honest in your answers so that the nurses and doctors can provide you with the best pain control.
10. What can I do to prevent complications during and after surgery?
Complications vary depending on the procedure you're having and your health status, so talk to your surgeon before the day of the operation to ask how you can minimize your risks. The majority of surgical patients receive antibiotics to reduce their chances of infection.
According to You: The Smart Patient, it can help to be proactive when it comes to oxygen and warmth. Because supplemental oxygen can reduce your chance of getting an infection, ask to have it during and after the operation. Cold patients develop more complications, so ask for a blanket to take with you into surgery and ask the anesthesiologist to keep you warm.
After surgery, make an effort to avoid complications related to heart, lung and kidney function. For example, to prevent lung problems, get out of your hospital bed and walk around and do deep breathing. Never be afraid to ask for assistance if you need it; you do not want to fall while trying to be mobile soon after surgery.
Your doctors and nurses will monitor your nutrition and fluid status to keep your heart, kidneys and intestines functioning as well as possible. Occasionally there will be a dip in the normal function of these organs, so don't be afraid to ask how you are doing, or if there is more that you can do to improve your healing process.
Since hospitals are filled with sick patients, they are notorious for harboring germs. To minimize your chances of hospital-related infections, keep a container of hand sanitizer by your bed and ask health-care professionals and visitors to wash their hands. Also, beware of hidden harbingers of germs, such as the TV remote, your wedding band, dirty stethoscopes and toilet handles.
Before you return home, ask your surgeon and primary-care physician who you should call in the event that something unexpected happens and you need urgent care. You want someone who can respond quickly and you want to know how best to contact them.
Be sure to follow through with your rehabilitation or physical therapy.
For more helpful information on being a smart patient, check out the Speak Up booklets by The Joint Commission.