Risks Of Surgery

It is important that patients understand the risks involved with surgery. The choice to undergo a surgical procedure should be based on the comparison of the risk to potential benefit. Although the majority of patients do not experience the following complications, you should discuss each of them with Associate Professor Johnstone to make sure you understand all possible consequences of the planned surgery.

All surgery is associated with some risk. Risks are minimised by appropriate patient selection, careful pre-operative planning, meticulous surgical technique and vigilant post-operative care. In general, the least serious problems occur more often and more serious complications occur rarely. When they do occur, every effort is made to resolve these problems as quickly as possible. Complications prolong the recovery period, but they uncommonly have a permanent effect on the final result. Re-hospitalisation is rarely required but this, in patients not covered by health insurance, can add to the cost of the procedure. Patients who are smokers, diabetic, overweight, who have had radiation treatment to the operative site or have other conditions impairing immunity or wound healing such as corticosteroid use, HIV etc also have an increased risk of complications.

RISKS COMMON TO ALL OPERATIONS

Bleeding and haematoma (bleeding into the tissues). This rarely requires a return to the operating theatre or a blood transfusion. Aspirin, as well as other non-steroidal anti-inflammatory agents taken up to two weeks prior to surgery, even as a single, small dose, can increase the risk of bleeding. Fish oil and many herbal treatments such as garlic, gingko, ginseng, green tea, and ginger can also cause excessive surgical bleeding. Patients on anti-coagulants need specific peri-operative management.

Wound separation or delayed healing

Inflammation and infection

Pain – the severity and duration of post operative pain varies with each individual patient. When a procedure is performed on both sides of the body, the amount of swelling and pain are rarely exactly the same. More pain and/or swelling on one side does not necessarily mean that a complication has occurred, although this should be reported to the surgeon.

Sore throat caused by the tube used to administer anaesthesia

Painful or infected intravenous line site

Nausea and vomiting. Modern anaesthetic agents and post operative medications usually but not always control vomiting.

Other anaesthetic complications. Any specific concerns should be discussed with the anaesthetist

Sensitivity or allergy to dressings and tape

Thick, wide, depressed or discolored scars

Unsatisfactory result and need for revisional surgery

Post-operative fatigue and depression. Physical recovery from the operation and the anaesthetic is gradual. Many patients may feel “emotionally low” post-operatively. This can occur after any surgery that has involved hospitalization and tends to improve over a number of weeks.

RARER COMPLICATIONS

Deep venous thrombosis (DVT) can lead to pulmonary embolism (PE). (Blood clots forming in the veins of the legs and floating to and blocking the blood vessels supplying the lungs). These events can be fatal (risk 1 in 1000 in major surgery such as abdominoplasty). The oral contraceptive pill and hormone replace therapy (HRT) can increase the risk of a DVT and should be stopped at least a month before surgery. Special precautions such as the use of antiembolic stockings, pneumatic calf pumps and heparin (anticoagulant) injections appear to significantly lower the risk of DVT and PE.

Severe allergic reactions to drugs used in anaesthesia are also rare (1 in 10,000).

Chronic pain.

Pressure effects- excessive, unrelieved or prolonged pressure on tissues can cause temporary or permanent damage such as “pressure sores”, death of muscle, such as “compartment syndrome” particularly in the limbs or nerve injuries resulting in paralysis, numbness, paraesthesia (abnormal and unpleasant sensation) and pain. The risk of these complications is increased in lengthy operations and in the obese, smokers, diabetics and medically compromised patients. Great care is taken to minimize these risks during operations.

Other rare complications of surgery include stroke, heart attacks, cardiac arrhythmia’s, etc., however these are extremely rare in otherwise fit patients.

SPECIFIC SURGICAL RISKS OF EACH PROCEDURE SHOULD BE THOROUGHLY DISCUSSED DURING A CLINICAL CONSULTATION

There can be no guarantee with any surgery. The realistic aim of any surgical procedure is improvement and not perfection. A further operation may be required to further improve the results or to deal with complications. The most common and most serious known complications are listed and can not form a complete list of every potential complication or mishap that could occur in the course of treatment, whether it is a consequence of the operation directly, the anaesthesia or as a result of being in the environment of an operating theatre or a hospital.