I appreciate the opportunity to be your physician. This surgery information guide should help you become an active participant in your surgical care. With your help, my staff and I will strive to provide you excellent, evidence-based preoperative and post-operative care! It is my hope that your perioperative course is seamless and without complication or issue. However, any surgery, no matter how small, always carries some risk, and certain patient populations are at higher risk than others.
Risks of any surgery:
The biggest patient-associated risk factors for heart attack within 30 days of surgery are personal history of heart disease or heart arrhythmia, diabetes, obesity, smoking, and family history of heart disease. If you have any of these risk factors, you may need cardiac clearance prior to anesthesia, to determine if surgery and anesthesia can be performed safely.
Blood clots in legs (DVT)/Blood clots in lungs (PE)
Blood clots in the legs and lungs can occur after any surgery. I encourage you to walk around as much as possible after surgery, even if you are sore, to help prevent blood clots. Patients undergoing longer surgical procedures, patients with a personal history of blood clots, and patients with cancer will have leg pumps (SCD’s) on at surgery to additionally lower their risk, and others may also receive blood thinner injectables after surgery.
Risk factors for pneumonia after surgery include prior history of COPD/emphysema and recent pneumonia. Current smokers, even young patients, are at much higher risk of respiratory issues during and after surgery. I encourage all patients to cough and deep breathe after surgery to keep their lungs inflated and lower the risk for pneumonia. Quitting smoking prior to surgery greatly lowers your risk.
Any surgery has a risk of wound infection, even if you are perfectly healthy and the surgery seems relatively minor. Some patients will receive one dose of antibiotics preoperatively, if indicated, to lower the risk of wound infection. The majority of patients do not need antibiotics after surgery, unless they develop a wound infection. After surgery, wash your hands thoroughly before and after touching/dressing your incision site. If you do develop a wound infection after surgery, most resolve with a short course of antibiotics. Wound infection rate depends on both the type of surgery you are undergoing and your own risk factors. Smokers, obese patients with a BMI over 30, and diabetics have been shown to have higher rates of wound infection, regardless of the type of surgery.
Seroma (fluid accumulation under incision)
Seromas are pretty common after certain surgeries, including breast surgeries, lipoma removal, and hernia repair. Most seromas resolve without intervention and are not harmful to you. A small number of seromas can become infected, and some become tender and may require aspiration in the office to relieve pressure. After surgery, if you were to develop a small amount of clear/pink/red/yellow fluid draining for your incision, most of the time it is a seroma. If this happens, it is not harmful to you, and you can just cover your wound with clean gauze, and change the gauze as necessary, and within a week or so the drainage will stop! If the drainage appears to have pus within it, however, please let me know about that.
Having a scar is inherent to any surgical procedure. Scars are most prominent in the first few weeks after surgery, when they look somewhat red and elevated. This appearance is due to the immature collagen that your body initially places at the incision site after surgery. Gradually over the next few months, your body starts to soften up the scar, when the immature collagen develops into normal mature collagen. Frankly, you do not need to do anything with your incision to minimize the scarring after surgery, other than avoiding getting your incision sunburned and keeping it clean. Patients often ask about scar creams such as Vitamin E or Mederma. The scientific support for both products is low; most patients will have a cosmetically acceptable scar several months after surgery by just letting time pass.
Poor Wound Healing
Infrequently, your wound may not heal well, despite proper wound closure. This is frustrating for both you and me, and is more common in certain patient populations. Smokers, diabetics, obese patients, patients who are immunosuppressed (from chemotherapy for cancer or from steroids for other medical conditions), and patients with low nutritional levels are at particular risk. If your wound does not heal well after surgery, and it appears to be a long-term problem, I often utilize the resources of the wound center for assistance and closer monitoring.
Surgery site discomfort is inherent to any surgical procedure. It is important to find a balance between pain control and limiting the risk of pain medications. Any narcotic medication can cause sleepiness, nausea, constipation, and should not be taken in excess of the prescribed dose. You will not be pain free after surgery, but our goal will be to keep your discomfort manageable. For some procedures, you will be prescribed a narcotic pain medication for use as needed after surgery. Many patients find that these narcotic pain medications are not necessary, and prefer to take either Tylenol or ibuprofen around the clock after surgery and this provides adequate relief. However, if you do need to use the narcotic medications, it is the office policy to not prescribe pain medications after hours and on weekends. If you believe you might need more pain medication, you must call the office during normal business hours so I can assess if your request is reasonable. Narcotic medication addiction has become a huge problem in today’s society. I encourage you to investigate the following FDA website about the safe use of pain medication after surgery: http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/ucm095742.pdf.
Specific Patient Populations are at Even Higher Perioperative Risks:
Smoking is detrimental to the surgical patient in multiple ways. Numerous studies have documented the increased risks of pulmonary, cardiac, wound infection, and wound healing complications in smokers versus non-smokers. A recent study from the Cleveland Clinic demonstrated that compared to non-smokers, smokers had a 80% higher risk of heart attack, a 73% higher risk of stroke, and a 50% higher risk of pneumonia. I urge you to visit the American College of Surgeons educational website for smokers: http://www.facs.org/patienteducation/quitsmoking.html
Patients with diabetes are at higher risk of cardiac complications during surgery. Postoperatively, poor glucose control is associated with poor wound healing and infectious complications. Hyperglycemia has also been shown to increase risks of pneumonia, urinary tract infection, and mortality after surgery. If you are a diabetic, I will ask you to work with your primary care physician or endocrinologist to keep your blood sugars tightly controlled to decrease wound and other more serious complications.
Obesity is common, serious, and costly. The most recent numbers from the CDC report that over one third (35.7%) of Americans are obese. Researchers from Johns Hopkins recently reported that obese patients with a BMI of over 30 have a twelve time higher risk of suffering complications in elective procedures versus non-obese patients. In breast and colon cancer patients, obesity is suggested is some studies as a risk factor for poorer prognosis.