Risks and Complications of Surgery
Safety Issues With Any Surgical Intervention
Whether it is abdominal surgery, plastic surgery, or any other invasive surgical treatment, it is dangerous to assume 100% safety.
Surgery has always been a vital part of modern medicine, able to treat certain conditions that other interventional means cannot. However, because of this medical miracle, it may be easy to forget the risks. In November 2007, the mother of rapper Kanye West, Donda West, died after undergoing plastic surgery. Although the risks of plastic surgery deserve considerable attention, these risks actually apply to any elective major surgery whose decision is up to the patient in nonemergency circumstances.
Anesthesia
Minor surgical procedures, like a skin biopsy of a suspicious mole, require only local anesthetic to the target area. It is not so for major surgery for which general anesthesia is used instead. This involves medication that induces unconsciousness and unawareness of all pain. An anesthesiologist also inserts an endotracheal tube into the windpipe to ensure safe respiration during the surgery. This deep state is required for the patient not only to avoid sensing surgical trauma, but also to avoid having uncontrolled involuntary movements.
People may like to think of general anesthesia as "being put to sleep". However, this is not the same as taking a sleeping pill. A sleep medication calms a person enough to rest, but it doesn't necessarily take away pain sensation. General anesthesia goes well beyond this and approaches the point where breathing and heartbeats could stop altogether. This is why general anesthesia requires careful monitoring by the anesthesiologist while the surgeon is performing the operation.
Bleeding
There is no doubt that cutting through the skin results in bleeding. As this happens, the surgeon stops the bleeding with hemostatic clamps or cauterization instruments to burn the vessels closed. Blood loss in this manner is generally minimal, but total blood loss by the end of surgery, especially with relatively long procedures, can add up. Surgical patients with anemia may require a blood transfusion before going into the operating room.
Cardiovascular Risks
For noncardiac surgeries, the heart continues to pump during the operation. If a heart attack (myocardial infarction) or worsening heart failure compromises this circulation, the situation can become critical. Events like this can also occur postoperatively. This is why a preoperative evaluation of a surgical patient includes assessment of cardiovascular risk factors. Patients with certain heart conditions have a level of surgical risk depending on condition severity.
Sometimes, the cardiac risk is greater than the risk associated with the condition requiring surgery. For example, a surgeon may not want to perform a colectomy for colon cancer because the patient is elderly, is known to have severe coronary artery disease, and has had one heart attack before. However, if that same patient were to bleed profusely from a ruptured abdominal aortic aneurysm, the aneurysm would be surgically repaired because the risk of death may be greater than the risk of a heart attack. Every medical decision, not just surgical, involves weighing the risks against the benefits.
Wounds
After the surgery, all internal and external wounds need to heal. A gradual healing process occurs that results in fibrous scar tissue in the wound. In the meantime, sutures or other material are used to hold large wounds closed. Pain management is also at issue when wounds are in their early stage of healing. Scars are often an issue for patients seeking cosmetic surgery, but in general, they are unavoidable.
Infections
Despite taking precautions, infections can occur while in the hospital. This is especially true for surgical wound infections. As with nonsurgical hospitalized patients, there is also the risk of acquiring other infections, such as pneumonia.
Pulmonary Risks
Postoperative patients have a risk of forming a blood clot in the leg (deep vein thrombosis) that breaks off and gets stuck in the lung circulation (pulmonary embolism). The stress of the surgery and the stasis of the legs while in the hospital bed, plus any other factors the patient may have, make the blood hypercoagulable and tend to form clots. Fortunately, the risk is lowered by daily administration of a blood-thinning medication, like heparin.
In addition, postoperative patients may feel weak, particularly with voluntary breathing. As a result, portions of the lung may collapse (atelectasis) and put the patient at risk for low blood oxygen levels (hypoxemia). To correct this, patients are strongly encouraged to use incentive spirometry. It involves a plastic device with a mouthpiece and a movable piston. The patient inhales slowly and deeply through the mouthpiece to move the piston upward, trying to reach a goal height for the piston. This exercise ensures adequate inflation of the lungs in the postoperative period. Other patients may not breathe well on their own and require being on a ventilator for the time being.
As with cardiovascular risks, certain pulmonary conditions, such as chronic obstructive pulmonary disease, are assessed preoperatively because they can increase a patient's surgical risk and prolong duration on a ventilator.
Final Words
With board-certified surgeons and anesthesiologists plus optimal patient care, these surgical risks are minimal. The purpose of describing these risks is to clarify that surgery is an invasive procedure that should never be seen as an easy process. At the same time, emergent operations and elective procedures with clearly great benefit should not be ignored just because of the risks. Again, the best choices are ones that result in benefits that outweigh the risks, an analytic principle that patients and doctors should always discuss with each other.
References
- Adler, Joshua S. "Preoperative Evaluation." Hospital Medicine. 2nd ed. Ed. Robert M. Wachter, Lee Goldman, and Harry Hollander. Philadelphia: Lippincott, Williams, & Wilkins, 2005. 249-259.
- Savel, Richard H., Wiener-Kronish, Jeanine P., and Michael A. Gropper. "Postoperative Care." Hospital Medicine. 2nd ed. Ed. Robert M. Wachter, Lee Goldman, and Harry Hollander. Philadelphia: Lippincott, Williams, & Wilkins, 2005. 261-269.
- Merck Manual - Care of the Surgical Patient
