Complications arising from surgery are a risk that everyone takes when they undergo an invasive surgical procedure. We know that some procedures have higher complication rates than others and that up to 40% of post-surgery complications actually occur after the patient has been discharged by the hospital.
So what are the issues, and what can you do to reduce the risks of complications? (If you want to get skip the background and get straight to the tips – head to the end of this article)
Any surgery carries with it risks. Generally, the risks of surgery are split into three categories:
- Risks associated with the particular procedure being undertaken.
- Risks associated with the specific patient.
- General risks of surgery.
Every procedure has its own specific risks
Firstly, no matter what we might like to think, when it comes to the risk of surgical procedures there is no getting away from the fact that some procedures have a higher complication rate than others.
Figures from a Grattan Institute calculator illustrate the point: 5% of people undergoing breast surgery experienced a complication, whereas the figure was only 2% for patients undergoing plastic and reconstructive surgery and 8% for patients undergoing orthopedic surgery. Not surprisingly heart surgery (cardiothoracic surgery) carries the highest complication rate at 54% according to the calculator.
Importantly, the research is pretty clear that there are two other important risk factors related to surgical procedures: the length of the surgery and undergoing more than one surgical procedure at a time.
Often, undergoing a combined set of procedures and a lengthy operation go hand in hand. Research that was focused on a broad range of complex plastic surgery procedures in the USA showed no change in the rate of complications until around 3 hours of surgery, after which the odds of complications started to increase by 3 times after 4.5 hours and nearly 5 times after 6.8 hours. Basically, surgeries resulting in complications had longer operative times than those that did not.
The American Society of Plastic Surgeons has also reported a study that showed the risk of complications as a result of combining surgical procedures such as abdominoplasty can triple (from 3.1% to 10.4%) when abdominoplasty was combined with body contouring and liposuction.
Patient specific risk factors
In addition to the risks of any particular procedure, there are certain things that increase your specific risks of undergoing surgery. These items include:
- Existing conditions such as a history of heart, kidney or liver disease, diabetes or asthma.
- Current symptoms such as coughing, chest pain or infection.
- Use of alcohol or tobacco
- Your Body Mass Index (BMI)
Additionally, in early 2018 researchers at St. Michael’s Hospital in Toronto, Canada, found that frailty (rather than old age) and depressive symptoms were also associated with developing postoperative complications following elective surgery.
The Research also found that 25% of older patients experienced some complications following elective surgery but that by improving a patient’s nutrition, physical fitness and cognition and ceasing to smoke before surgery could lower the risk of postoperative complications.
Recognizing that every patient is different and has different risk factors with regards to complications, The American College of Surgeons also has an excellent calculator to estimate your particular surgical risk.
Complications and General Risks of Surgery
No matter what your physical condition or the type of procedure you are going to undergo, there are a number of general risks and complications that you should be aware of.
Comparing actual rates of post-operative complications across countries and even across medical facilities in the same country is difficult due to the lack of universally agreed definitions. Although very serious complications certainly can occur after surgery, figures from the UK show that a small group of ‘high risk patients’ account for a very large percentage of actual deaths.
In addition to pain, bruising and nausea some of the more common post-surgery complications include:
- Wound infection – When bacteria enter the site of surgery, an infection can result and may delay healing. Wound infections can spread to adjacent organs or tissue, or to distant areas through the blood stream.
- Rapid blood loss from the site of surgery, for example, can lead to shock. Shock is the dangerous reduction of blood flow throughout the body and is most often caused by reduced blood pressure.
- Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)
- Reduced Bowel Function and Urinary retention. Constipation and/or the inability to empty your bladder, may occur after surgery due to the drugs or anesthetic used during surgery.
- Pulmonary complications – Sometimes, pulmonary complications arise due to lack of deep breathing within 48 hours of surgery. This may also result from inhaling food, water, or blood, or pneumonia.
Over 40% of post-surgical complications occur after patients have been discharged from hospital.
An American study from over 250 US hospitals, including 551,510 patients who underwent surgery as an inpatient (meaning they stayed at least 1 night in hospital) showed that 16.7% of patients experienced a complication of which 41.5% of those complications occurred post-discharge.
What this means is that it is critical that discharge planning should include contingency plans for managing problems commonly diagnosed after discharge from hospital.
Ten Tips for managing the risk of complications following surgery
- Make sure that surgery is the right option for you in the first place. Are there non-surgical options, or less invasive surgical options that you could consider?
- Ask questions: every procedure has known risks and complication rates. Does your surgeon have a better or worse than average rate of complications from the type of procedure you are considering?
- Ensure you have a surgeon with excellent qualifications, training and plenty of experience in the procedure that are considering. Read our blog here that highlights:
- Look after yourself! Losing weight, quitting smoking and cutting back on alcohol will all reduce your potential risk.
- Ensure that the medical facility that you are considering going to not only complies with local regulations but meets world best practice standards. Ask about critical items such as compliance with the World Health Organisations Surgical Site Infection prevention guidelines. Even in a country like the U.S.A surgical site infections contribute to an extra 400,000 days a year in hospital.
- Don’t combine procedures unless you absolutely have to and talk to your surgeon about the alternatives of staging rather than combining the surgery. The more procedures you combine and the longer your surgery – the higher the risk of complications.
- Don’t sacrifice quality for cost. You should seek out the best quality providers at the best price. There are highly qualified and board certified surgeons and top quality medical facilities in many countries around the world – you just need to do your homework to sort the great from the good.
- If you are traveling for surgery (no matter whether it’s to a different country a different city or even a few hours from home) you will need to have continuity of your medical care from preparation and planning phase to the actual surgery followed by your recovery phase.
- Your recovery is critical. Once you are discharged from hospital, ensure that you make an appropriate decision about where you stay. If you are going straight home then make sure that you have someone available to assist you if required and if you are heading to a hotel or other accommodation, then make sure that they are aware of your condition and equipped to assist you if required.
- Surgery is not a single event that starts and ends at the hospital. There are a number of things that you need to research to ensure that your surgical journey from research to recovery is successful and has the lowest possible risk of complications. Find some trusted information sources and you will be well on your way to a making very informed decisions about your most valuable asset – your health!