Surgery Benefit and Risk Assessment

Surgery Benefit and Risk Assessment

Objective evaluation of the reasons and expectations for a surgical OPERATION. Surgery is a common therapeutic approach today, with surgeons in the United States performing more than 25 million operations a year. Risks and complications related to surgery and ANESTHESIA have declined dramatically over the past three decades, making surgery one of the safest and most effective treatments for many health conditions. However, surgery is often not the only therapeutic option for a particular condition or health circumstance. It is important to fully understand

  • the specific operation the surgeon recommends and why
  • the expected benefits of the operation
  • other surgical operations that might also treat the problem
  • the possible nonsurgical treatments for the condition
  • the potential risks of the operation itself
  • how the operation’s risks compare to the risks of other treatment options (including nontreatment) for the condition

Some people need time to think through their options, the reasons the surgeon recommends the operation, and the possible complications of the operation. There is usually no hurry to schedule an elective operation, though symptoms such as PAIN may make the scheduling timely. It is often helpful to write down questions and concerns, then schedule an appointment with the surgeon to discuss them before making the decision to proceed with surgery.

The surgeon who will perform the operation should be qualified and experienced. Many hospitals are teaching centers where surgical residents (trained physicians who are learning advanced skills in surgery) participate in operations. They do so under the direction and close supervision of the primary surgeon. Teaching hospitals are required to obtain signed permission for staff who are in training (physicians, nurses, and ancillary staff) to participate in care delivery, including surgery. As well, for most operations the surgeon has at least one other surgeon assisting him or her. A person should know who will actually be performing the operation and the other doctors who will be assisting because these are factors that may influence the outcome of the surgery.

Surgery Benefits

The benefits of surgery are numerous and mostly specific to the planned operation. In general, surgery corrects or repairs defects, injuries, functions, or appearance. Surgery may be lifesaving, as in major trauma or CORONARY ARTERY BYPASS GRAFT (CABG), and is the first line of treatment for many forms of cancer. Surgery may also be palliative, such as to reduce pain, pressure, or other discomforts that may occur in chronic health conditions such as NEUROPATHY or terminal cancer. It is important to discuss with the surgeon the anticipated or hoped for benefits of the recommended operation.

Potential Benefits of Surgery
correct congenital defects improved appearance
improved function relieve intractable PAIN
removal of tumors treat injuries or conditions

Surgery Risks

All operations have general as well as specific risks. General risks include excessive bleeding, wound INFECTION, PNEUMONIA, and death resulting from unanticipated crisis during the operation (such as HEART ATTACK or STROKE). Surgeon error is also a risk for any operation.

Personal health factors that increase surgical and anesthetic risks include cigarette smoking, ALCOHOL use, OBESITY, DIABETES, CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), HYPERTENSION (high BLOOD PRESSURE), CYSTIC FIBROSIS, and CORONARY ARTERY DISEASE (CAD). Numerous medications (including herbal products, over-the-counter products, and illicit drugs) can interfere with anesthesia, BLOOD clotting, or HEALING.

Age alone does not increase risk for surgical complications. However with advancing age the likelihood of numerous health conditions increases, many of which can remain undetected until a stress such as anesthesia or surgery brings them to the forefront of the person’s health picture. Such health conditions may include type 2 diabetes, ATHEROSCLEROSIS, CAD, renal (kidney) disease, LIVER disease, and sometimes hypertension.

POSSIBLE RISKS OF SURGERY
ANESTHESIA reaction death
excessive bleeding during or after surgery failure of the OPERATION to resolve the condition
intestinal adhesions need for BLOOD TRANSFUSION
nerve injury outcome other than expected
PNEUMONIA unacceptable SCAR appearance
worsening of health condition wound INFECTION

Second Opinion Consultation

A second opinion is an assessment from another specialist who provides treatment for the same condition for which the surgeon recommends an operation. The specialist is often another surgeon though may practice in a different subspecialty of surgery. For example, a person considering back surgery as treatment for HERNIATED NUCLEUS PULPOSUS (“ruptured disk”) may have a surgery recommendation from an orthopedic surgeon and seek a second opinion from neurologist, as both specialties treat back problems. A person may also seek a second opinion from a specialist who is not a surgeon, who may recommend nonsurgical treatment options.

Because there are often numerous options for treating a particular health problem and surgery is inherently invasive (a treatment that enters the body), health experts recommend a second opinion consultation for most elective (nonemergency) operations. People sometimes worry that seeking a second opinion will offend the first surgeon in some way. However, current standards of practice support second opinions, and surgeons are themselves often the first to recommend them. Some health insurance plans require second opinion consultation for certain, and sometimes all elective, operations.

The second opinion surgeon or physician should

  • be board-certified in an appropriate and relevant specialty
  • practice in a different group or facility from that of the first surgeon
  • know the consultation is for a second opinion
ELECTIVE OPERATIONS FOR WHICH HEALTH EXPERTS URGE A SECOND OPINION CONSULTATION
adenoidectomy cancer operations
carpal tunnel surgery CATARACT EXTRACTION AND LENS REPLACEMENT
CHOLECYSTECTOMY CORONARY ARTERY BYPASS GRAFT (CABG)
DILATION AND CURETTAGE (D&C) HERNIA repair
hemorrhoidectomy HYSTERECTOMY
JOINT REPLACEMENT knee surgery
MASTECTOMY PROSTATECTOMY
tonsillectomy vein ligation and stripping

The surgeon or physician providing the second opinion consultation will require medical records, diagnostic procedure reports, laboratory test results, and other information relevant to the condition. The doctor will conduct a thorough examination of the person, then discuss the findings and his or her professional opinions about the possible treatments. The second opinion may or may not support the initial recommendation for the operation. The person may choose which physician or surgeon will provide the recommended care. A complex health circumstance may require multiple consultations from different specialists, in which case it may be helpful to have one’s primary-care doctor assist in sorting through the options, benefits, and risks.

Informed Consent

Informed consent documents describe in detail the proposed operation, reason for the operation, recommended anesthesia options, expected benefits, and possible complications and risks. Informed consent is required before the operation may begin for all surgeries except in certain life-threatening circumstances. The informed consent documents should contain no surprises or new information; if they do, it is important to discuss the situation with the surgeon before signing them. In some circumstances the surgeon may request advance permission to perform a more extensive operation than planned, depending on the findings during the surgical operation. This permits the surgeon to do what needs to be done in a single operation rather than having the person go through a second procedure.

See also CANCER TREATMENT OPTIONS AND DECISIONS; QUALITY OF LIFE.

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