Thinking About Surgery?

Having surgery is a serious consideration, and you should think about it seriously. Keep in mind, at the same time, that while surgery might be rather strange and unusual to you, it is actually very common in my practice as an orthopaedic surgeon.


The decision to have surgery is a team effort. I need to explain it clearly to you, and you need to have a good understanding about what we are discussing.  We both need to consider all the options, and then together come to a reasonable conclusion that having surgery is better for you than not having surgery.  In the end, the decision to have surgery is up to you, because only you know how much your problem is interfering with your enjoyment of life, and how willing you are to accept the possibilities in your future. 


Here are some things to think about:

1. Do you understand what we talked about in the office?


2. Do you feel that you have tried all the appropriate non-operative possibilities? In some cases, like an infection or an open fracture, there may not be any reasonable alternatives besides surgery, but most of the time, there are non-operative alternatives that are reasonable. You should not have surgery until you understand and have considered the non-operative possibilities and decided that they are not a reasonable option for you. Discuss this with me if you are unsure.


3. Have you considered the possibilities if you do NOT have surgery? I will try to tell you what you can expect if you do not have surgery. Sometimes, the problems of NOT having surgery are close to zero (for example, living with your arthritis for a bit longer), but sometimes they are serious; not having a cat bite abscess cleaned out, for instance, may cause the loss of function of part of your hand or even death if the infection rages out of control.  Discuss with me the possibilities that might happen if you do NOT have surgery.


4. Do you understand the expected, possible, and the unlikely outcomes of your particular surgery?  Unrealistic expectations will make both of us unhappy. For instance, the pain of arthritis in your hand will not be cured by surgery for carpal tunnel syndrome.  Know exactly what your diagnosis is, what the surgery is intended to treat, and what results you can expect. For example, arthritis surgery is generally designed to decrease your pain but it won’t necessarily eliminate all pain, and fracture fixation is designed to improve your bone position and increase your chances for good function, but it is will not necessarily make everything “normal” (that is, run the clock back in time to before you had your fracture). Obviously, getting things back to being as close to normal as possible is our goal.  Understand the expected, possible, and unlikely outcomes of your particular surgery.

5. Do you understand the likely, the possible and the rare complications of your particular surgery? Complications are rare, but even if the risk is 1%, or 1 in 100, if it’s you, it becomes 100%.  Almost all surgeries have the risks of:

a) Infection. We generally give you antibiotics right before surgery to help prevent infection, and the risk is rather small, usually less than 1 in 100. 

b) Nerve or blood vessel damage. 

c) Failure to completely cure the problem.  We might not be able to relieve every symptom you have by operating, depending on a bunch of different factors.

d) Recurrence of symptoms.

e) Rare problems like complex regional pain syndrome (CRPS).

f) Anesthetic complications, the possibility of which increases if you have multiple medical problems or are very ill.  You will get to talk to your anesthesiologist and nurse anesthetist before surgery; they will be able to help you decide what anesthesia choices are best for you.

6. Are you taking blood thinner medication? If so, you will want to check with the doctor who prescribes them for you to determine whether they can be stopped for surgery and if so, how you should change your treatment.  If you are on this medication for very serious conditions, that does necessarily mean that you can’t have surgery.  I use a tourniquet for most procedures.  We might have to modify our plan a little, but it is most important that you are safe!

I will discuss with you any other complications which might be peculiar to your particular surgery.  I also will talk to you prior to surgery in case you have any last-minute questions. Remember, common things happen commonly and rare things are rare.