Just prior to surgery I usually sit the patient down and we have a long discussion as far as the treatment plan and share the decision making as far as what the actual surgery entails. I also spend time with the patient going over what’s called Informed Consent. And this is a legal informative block of information for the patient so they can understand exactly what they are getting into and what they should expect, or a possibility to expect. Unfortunately, in this day and age this is usually a legal issue that comes back to haunt doctors and patients and I recommend highly that if your particular physician does not go over this with you, you may want to think about getting a second or third opinion as to what are the potential problems. Most of the time patients do well and that’s one of the things that we like about the whole operation.
We want to try to maximize the benefits and minimize the risks. But unfortunately, no one is 100% perfect and we don’t live in a 100% perfect world. The problem we see is the risk associated with surgery and most of the general risks I’m going to outline include bleeding potential during and afterward, infectious potential during and afterward. These usually are treated immediately, at the same time as surgery with controlling the bleeding. The infection aspect is usually treated by giving the patient preoperative antibiotics. This is a sketchy thought that had been going on for several years in which people feel that there are too many antibiotics being given and we’re selecting out microorganisms that become very dangerous. With this in mind, through the CDC and regulatory bodies, the particular antibiotics are usually given approximately 1 hour prior to surgery and they’re usually discontinued within 24 hours. This maximizes the open wound possibility for infection yet minimizes the chance that the patient will develop an infection from an antibiotic that had killed a particular microorganism and unfortunately made the patient susceptible to something else.
So by minimizing the antibiotics and minimizing the open wound time that helps to decrease the chance for infection. Again, most of the risk benefits, I’m sorry, most of the risks that are associated with this are usually less than 1% but some of the other ones include stiffness after the surgery and this is due to scar tissue formation and the body’s natural process of healing. The other probability and possibility is what’s called a DVT or deep vein thrombosis. More frequently it’s called a clot. We see these more frequently in lower extremity surgeries such as hip replacements, knee replacements, even arthroscopy or even fracture care.
This is when the blood pools and the actual clot forms. If the clot forms in the leg it’s called a DVT or deep vein thrombosis and it can be treated conservatively. It’s when the clot begins to propagate or parts of the clot break off and this can go into the other parts of the body such as the brain and these are called emboli. The unfortunate consequence can be a stroke in the brain or if you have pulmonary emboli that frequently can cause the patient to expire, an unfortunate incidence but luckily a very rare incidence. The other issues that we have and should be explained to the patient is that sometimes there is failure of the surgery.
A lot of patients can have unrealistic expectations which we try to outline to try to minimize this particular possibility and educate the patient for the post-operative period. Unfortunately, patients do have failure at surgery such as hardware breaking, the bones not healing properly, or the actual tissue itself not healing in either a knee surgery or a shoulder surgery. The unfortunate happenstance is that sometimes patients do have to go back for a repeat surgery for correction or improvement of what had happened.
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