• Elective Surgery: Weighing the Risks and Benefits

    Rerun image Some surgery must be performed immediately, usually because an emergency has required it.
    But the majority of surgeries are elective surgeries—they are planned, non-emergency procedures. They may be medically necessary (eg, cataract surgery) or optional (eg, breast augmentation). If your doctor recommends you have an elective surgery, you should carefully weigh the risks and benefits of the procedure and make sure it is right for you.

    Finding the Right Doctor and Hospital

    It is important to feel comfortable with the doctor who will be performing your surgery. You can work with your primary care provider and/or healthcare plan to find a doctor who has the training, experience, and professional manner to meet your needs.
    One factor you may want to consider in choosing a surgeon is where she practices. Look for a hospital that has a lot of experience and success in treating your condition. Ideally, the hospital should be accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and be rated highly by government and consumer organizations devoted to evaluating quality of care.
    Even after you have found a doctor you are comfortable with, you may want to get a second opinion. Your doctor or health plan provider can help you find someone to provide a second opinion. Friends and coworkers may also know of doctors they can recommend. Before you go for a second opinion, check with your insurance company to see if it will pay for the consultation. And be sure to bring your records from your first doctor.

    Asking the Right Questions

    Once you find the right surgeon for you, the following list of questions may be helpful to ask when deciding whether to have an elective surgery:

    Why Should I Have This Surgery?

    Will it help relieve pain or other symptoms you are having? Will it fix your medical problem? Can it save your life? Make sure you understand why the surgery is going to be performed and how it can help treat your condition or problem. Ask your surgeon to detail what you will gain by having the surgery. Do not expect your surgeon to promise a favorable outcome. Although he may be optimistic about your prospects for recovery, there are no guarantees for success.

    Are There Any Alternative Treatments to the Surgery?

    Surgery is not always the only treatment for a medical problem. In fact, it’s often saved as the last resort. Alternative treatments, such as changing your diet, exercising, quitting smoking, or taking medications, can be just as effective—or even more effective—than surgery with fewer risks. It is essential that your surgeon carefully reviews all your available options with you before proceeding with surgery.

    What Are the Risks of Having This Surgery?

    All surgeries have risks—some more than others. Discuss with your surgeon what complications are linked to the surgery you are going to have (eg, infection, bleeding, reaction to anesthesia). What is the likelihood of experiencing these complications? What are the side effects associated with the surgery? What will be done to help prevent or relieve them?

    What Will Happen If I Do Not Have This Surgery?

    Will you have more pain? Will your symptoms get worse? Could the condition improve on its own?

    What Does the Surgery Involve?

    You should have a good understanding of the basic steps of your surgery. Find out if there is more than one way to do the procedure. For example, some surgeries can be performed through several small incisions rather than one large incision. This is called a laparoscopic procedure and is may be preferable since it is generally safer and permits a more rapid recovery.

    Where Will the Surgery Be Performed?

    Most surgeries are performed at a hospital, but some can be done in your doctor’s office. Find out where your surgery will be performed and what resources will be available if complications arise.

    What Kind of Anesthesia Will I Need During the Surgery?

    Anesthesia is used to prevent or reduce pain during the operation. In local and regional anesthesia, a part of your body is numbed for a period of time, but you will remain awake. In general anesthesia, you will be asleep for the duration of the operation. An anesthesiologist can explain the risks and benefits of the type of anesthesia you will be receiving.

    What Will Recovery Involve?

    Will you be able to go home the day of your surgery? Or will you need to remain in the hospital overnight or longer? After you get home, what will you be able to do—or not do—in the days, weeks, and months after surgery? What equipment and/or help will you need as you recover? How long will it be before you can go back to work or start exercising again?

    How Much Will the Surgery Cost? Is It Covered by the Insurance Plan?

    Surgery is extremely expensive. Few people can afford to pay for all the services typically involved in even a simple, routine operation. If you are uninsured and your surgery is essential, talk to your doctor and hospital to find out about ways to offset the costs.
    If you have health insurance, you may still have to pay for some expenses out-of-pocket. Some insurers will only pay for surgery they deem necessary. Be sure to contact your insurance company and find out how much they will cover and what portion of the bill will be your responsibility. This will avoid any unpleasant surprises after surgery.

    Making an Informed Decision

    Once these and any other questions have been answered to your satisfaction, you should feel comfortable making an informed decision regarding your surgery. Do not hesitate to ask if there is something you do not completely understand. It is the responsibility of your surgeon, the staff at your hospital, and your insurer to make sure you are fully informed.
    Weigh the benefits and risks of the procedure carefully to decide if the surgery is best for you. If the risks of the surgery are relatively low and the benefits are high, you may appropriately decide to proceed. But if you are worried about the procedure’s risks and learn about an effective alternative treatment, you may reasonably decide against the surgery. The decision is ultimately yours.

    RESOURCES

    Agency for Healthcare Research and Quality http://www.ahrq.gov/

    American College of Surgeons http://www.facs.org/

    CANADIAN RESOURCES

    Healthy U http://www.healthyalberta.com/

    Insurance-Canada.ca http://www.insurance-canada.ca/index.php/

    References

    Choosing quality health care. Agency for Healthcare Research and Quality website. Available at: http://www.ahrq.gov/consumer/guidetoq/guidetoq8.htm. Accessed June 6, 2006.

    Choosing treatments. Agency for Healthcare Research and Quality website. Available at: http://www.ahrq.gov/CONSUMER/qnt/qnttreat.htm. Accessed June 6, 2006.

    Giving your informed consent. American College of Surgeons website. Available at: http://www.facs.org/public%5Finfo/operation/consent.html. Accessed August 27, 2008.

    Having surgery? What you need to know. Agency for Healthcare Research and Quality website. Available at: http://www.ahrq.gov/consumer/surgery/surgery.htm. Accessed August 27, 2008.

    Hospitals—fast track. Joint Commission on Accreditation of Healthcare Organizations website. Available at: http://www.jointcommission.org/AccreditationPrograms/Hospitals/. Accessed August 27, 2008.

    Types of surgery. Children’s Hospital of Philadelphia website. Available at: http://www.chop.edu/consumer/your%5Fchild/condition%5Fsection%5Findex.jsp. Accessed August 27, 2008.

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