There are many mysteries about surgery, including why it’s usually scheduled in the morning, the best ways to avoid errors and infections, and why it’s safer to avoid having an operation in July.
Another scary question: “Patients always wonder, ‘Will I wake up during surgery,’” says Marc Gillinov, MD, author of Heart 411 and a heart surgeon at Cleveland Clinic. Fortunately, he adds, “The answer is no: We monitor the depth of your sleep with an EEG-like device.”
More than 15 million Americans have surgery annually, and in some cases, what they don’t know could hurt them. But there are steps you can take to reduce your risk of a bad outcome, including getting a second or third opinion and exploring nonsurgical options. Here’s an insider guide to what every patient should know before going under the knife.
People who live in an area with a lot of surgeons are more than ten times more likely to be advised to have certain operations than are people in areas with fewer surgeons, according to a shocking Dartmouth report.
If that’s not enough to raise your hackles, consider this: one hospital chain was shown to perform unnecessary heart surgery on patients, some of whom didn’t even have heart disease, the New York Times recently reported.
Many surgeries take place in the morning because an operation may be lengthy and patients aren’t supposed to eat beforehand. Hunger, thirst, and often nervousness can wear on the patient as the day goes on.
Although surgeries can take place any time of day, patients have fewer problems with anesthesia in the morning compared to the afternoon, according to a study published in Quality and Safety in Health Care.
Researchers looked at data from over 90,000 operations and found that nausea and vomiting after surgery, pain management problems, and other post-operative complications were four times as likely in operations which started at 4 p.m. compared to those which began at 9 a.m.
Experts also caution patients to watch out for the “July Effect.” That’s because July is the worst month for fatal hospital errors, making it the most dangerous time to have surgery. The main reason is that July is when inexperienced, often sleep-deprived medical school graduates start residencies at teaching hospitals.
Researchers from University of California at San Diego reviewed more than 62 U.S. million death certificates issued between 1979 and 2006, including those of 244,388 people who were killed by medical mistakes and found that the rate of errors was similar in most months but peaked in July at teaching hospitals.
Dr. Ken Waxman, MD FACS, Director of Quality at Ventura County Healthcare Agency recommends that facilities use surgical checklists, such as the list published by the World Health Organization. “The operating team must be mandated to perform all of the safety measures on this check list before and after every procedure. If not, don't have your operation at that hospital,” he advises.
Surgical sponges and other tools (including scalpels and clamps) have been left inside of patients, causing infections and other complications. To address the issue, some hospitals have begun using radio frequency tags to alert surgeons if sponges are left inside the patients.
Other hospitals use bar codes and scan sponges before they are used and after they are removed. Dr. Gibbs of NoThing Left Behind, a national project to prevent retained surgical items, told the New York Times that technology should be used in addition to counting sponges manually.
Another concern is that surgeons will operate on the wrong limb. To prevent this, says Dr. Gillinov, “Restate the operation. Say something like “Thank you for fixing my left knee.” Some patients even write “wrong leg” in magic marker on the limb that doesn’t need surgery.
This may seem contradictory, but Dr. Scott Gottlieb, New York Eye and Ear Infirmary Director of Pain Management, emphasizes the importance of coming into surgery in good health. “Don’t rely on the surgery to ‘fix’ all your problems. Maintain a healthy diet and active lifestyle prior to the day you are scheduled to go. Recovery is always better with patients in optimal health,” he says.
Orthopaedic surgeon Dr. Elton Strauss, who is affiliated with Mt. Sinai School of Medicine, echoes the sentiment. “If you’re a smoker, you should stop smoking. If you’re a drinker, you should stop drinking prior to the surgery” for at least two weeks. He also recommends increasing water intake for two weeks.
“I think it’s important to make sure you are honest with your physician prior to the surgery about the medications you take,” says Dr. Strauss.
“Today many patients take over-the-counter drugs and supplements that can complicate surgery. Patients don’t think about these drugs as being a problem, but they are. Vitamin E, fish oil and St. Johns Wort, to name just a few, cause a lot of bleeding issues,” he said.
Neurosurgeon Alain C.J. de Lotbinière recommends washing up before checking in--and has another surprising suggestion. “A very simple thing to prepare for surgery is to shower the day of the procedure with an anti-bacterial soap. You would not believe how many patients present for surgery in a filthy condition and then wonder why they experience post-op infections!” he groused.
In addition, make sure that staff members wash their hands and don fresh gloves in your presence before touching you.
Tarrytown, N.Y.-based book author Caitlin Kelly, who recently had hip replacement surgery, recommends taking hygiene precautions after surgery as well to guard against infection. “We bought a bottle of hexachloride solution (the same stuff surgeons use to wash their hands before surgery).”
“The visiting nurse was very impressed with our thoroughness (in home wound care), and my recovery was excellent,” she reports.
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