What Are The Risks Of Surgery

What Are The Risks Of Surgery – Surgeons are encouraged to make shared decisions when the patient’s risk of surgical complications outweighs the potential benefit of surgery.

In a new essay, Hopkins surgeons address the many ethical issues involved in selecting patients with certain risk factors for surgery. Credit: iStock

What Are The Risks Of Surgery

In an essay published July 26 in The New England Journal of Medicine, Johns Hopkins University School of Medicine researcher Ira Leeds and David Efron, professor of surgery, along with their colleague Lisa Lehman. The US Department of Veterans Affairs MD, PhD, MSc urges shared decision-making when a patient’s risk of surgical complications outweighs the potential benefit of surgery.

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“The ethical use of health care resources, the skill and experience of surgeons, and patient preferences come into play in the presence of known risk factors that predict poor surgical outcomes, including obesity, smoking, diabetes, and age,” says Leeds. “Our essay points to transparency, high-value care, public reporting and reporting of clinical outcomes, and the patient dilemma of whether or not to operate, and the reality for surgeons and patients.”

In the essay, the authors acknowledge that surgeons must now consider not only how poor outcomes affect the patient, but also how those outcomes may affect their individual and institutional assessments of quality. insurance companies and Medicare/Medicaid payments. According to Leeds, there are ethical issues with choosing the outcome of the surgery. Selecting the healthiest patients for surgery according to current quality measures is a simple way to improve outcomes. However, surgeons have an ethical obligation to focus on the patient when making decisions. For sick and debilitated patients, postponing surgery may help in the long run, but for others, postponing surgery may be ethically unbalanced, benefiting the institution or society as a whole rather than individual suffering.

Among the options and decisions surgeons and patients need to consider are when and how long to delay surgery until risk factors can be modified, and when to forgo risk factor modification to alleviate a patient’s surgically correctable condition, Efron said. situations – even dangerous. In the essay, Leeds and Efron consider the equitable distribution of limited health care resources as a factor in risk assessment. For example, is it better to perform one high-risk operation or two medium-risk operations that use the same level of medical resources? A recent analysis, the authors noted, found that obesity increased hospitalization costs for heart surgery patients by an average of 17.2 percent, or $426 for each unit of body mass index. Should such a cost analysis be part of the decision to work or not to work? More importantly, who should make these assessments? The authors argue that the proximity of operating surgeons and patients to the consequences of the decision requires greater involvement of professional societies and other impartial third parties.

The root of the conflict in the process of surgical selection, according to Leeds and Efron, lies in the inconsistency of the goals of patients, surgeons and society. More effective shared decision-making through clear communication of surgical risks and responsibilities to patients, clear surgical guidelines from professional societies, and ongoing support from insurance companies can help align goals.

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Click to tweet from @IraLeeds_MD @hopkinssurgery: When is the risk of surgery too high? Who should decide? A new @NEJM essay explores the delicate balance a surgeon must strike when making decisions. All surgeries carry a risk of complications, although plastic surgery is generally safer than invasive surgery. In general, complications are rare, but some complications are more common with some procedures than others.

Complications of anesthesia: Some patients, especially those who are obese or have heart or lung disease, experience an adverse reaction to anesthesia. Complications range from reduced blood flow to brain damage due to airway irritation that causes spasms and blocks airflow. Rare but possible complications include malignant hyperthermia (dangerously high body temperature, heart rate, and blood pressure) and death.

Bleeding: Some bleeding during surgery is normal, but too much blood loss can cause a dangerous drop in blood pressure that can lead to a heart attack.

Blood clots: These occur most often in the legs and are common during long surgeries and general anesthesia. A blood clot that blocks a blood vessel can cause damage to nearby tissues. If it breaks off and enters the lungs or heart, it can be fatal.

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Infections: The sterile environment and use of antibiotics make this complication rare, but when it does occur, it can be very serious and requires immediate treatment.

Necrosis: Dying of some tissue is normal during surgery, and the body can clear the dead cells on its own. If too much tissue has died, surgery may be needed to remove it. This can affect the final appearance of the cosmetic procedure.

Nerve damage: Small nerves are always damaged during a skin incision, but serious nerve damage is rare and usually the result of surgeon error. Permanent, devastating damage occurs 1 time per 1000 page loads.

Asymmetry: The human body is not perfectly symmetrical, so a slight imbalance between the two sides of your face or body is normal, but a noticeable difference may require additional surgery to correct.

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Hematoma: This is a collection of blood outside the blood vessels around the surgical site. The body can usually clear this up on its own, but sometimes it needs another operation. This is more common after a facelift and is more common in men than women who have excess blood in their beard follicles.

Seroma: Serum, the clear, watery part of the blood, can leak from damaged blood vessels. A seroma is a collection of fluid around an implant or surgical incision. This most often occurs after a tummy tuck, as well as after liposuction and breast augmentation.

Scarring: Scarring is normal after any surgery, but should be avoided during surgery to help you feel better. Experienced surgeons know how and where to cut to minimize scarring.

Numbness: Temporary numbness is common after facelifts, tummy tucks, and breast surgeries. This is typical for any implant.

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Ptosis: This is a fancy name for drooping and drooping. This is quite common after eyelid surgery, but it’s easy to fix.

This may seem like a long and even scary list of complications, but such risks are rare, and plastic surgery is usually one of the safest operations. Needless to say, liposuction is the most dangerous cosmetic procedure you can have. Common complications range from blood clots to organ puncture and infection. Bowel perforation is particularly dangerous because it can send intestinal bacteria into the abdominal cavity, causing a very dangerous infection. Also, if your skin is fresh and hasn’t shrunk to make you slimmer, you may need additional surgery to remove excess skin.

Some pre-existing conditions, such as diabetes, high blood pressure, and heart or lung disease, can increase the risk of complications. Smokers have a higher risk of some complications. Performing more than one procedure at a time increases the risk.

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