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| Although the objective of surgery is to save lives, surgery can also cause harm. Photo: AFP |
Surgery is often the only treatment for many common conditions.
It can be arranged electively or as an emergency.
The former is scheduled in advance by the patient and/or the doctor, and the latter is provided in trauma or acute conditions that present as an emergency.
Emergency surgery includes unplanned surgery for patients admitted in an emergency and unplanned surgery for patients awaiting elective surgery.
Although the objective of surgery is to save lives, surgery can also cause harm.
According to the World Health Organization (WHO), the risks of surgery include reported crude mortality rate after major surgery of 0.5%-5%; complications after inpatient operations in up to 25% of patients; and nearly half of all adverse events in hospitalised patients in advanced economies are related to surgical care.
At least half of the cases in which surgery led to harm are considered preventable.
The Health Ministry reported 1.039, 1.033 and 1.052 million surgical operations in its hospitals in 2012, 2013 and 2014 respectively.
There were one, one and five reports of “wrong” surgery in 2013, 2014 and 2015 respectively, of which three were wrong site surgery.
There were 13, 17 and 15 reports of unintended retention of foreign bodies in the Health Ministry, armed forces and private hospitals in 2013, 2014 and 2015 respectively, involving 11 hospitals each year. (Source: http://patientsafety.moh.gov.my/uploads/pscbook/pscbook.html; Accessed March 20)
Whilst hospitals and surgeons do their best to ensure that surgery is as safe as possible, there is much an individual patient can do for himself/herself.
Need for surgery
Discussions on the need for surgery should be carried out with the surgeon performing the procedure, and not a proxy, irrespective of whether it is another doctor or nurse.
Some of the following questions may help guide discussions.
• Why is surgery necessary?
• Are there alternatives to surgery, and if so, what are they?
• What are the risks of not having surgery?
• What does the surgical procedure involve?
• What are the expected benefits and risks?
• Is there a waiting list?
• What should be done if the condition improves or worsens while waiting for surgery?
• What are the anaesthetic risks?
• How can one prepare for surgery?
• What should one expect after surgery?
• What is pain after surgery like and how will it be managed?
• How long does it take to recover and what is the follow-up care needed?
• What should be done if one changes the mind about surgery, if rescheduling is requested, or if the condition improves and one feels that surgery is no longer needed?
The above questions are not exhaustive and individual patients and/or caregivers are advised to ask any and everything that comes to mind about the proposed surgical procedure before agreeing to it.
Knowledge about what to expect before, during and after surgery helps to ease patients’ fears and enables them to play an active role in their recovery.
Such information is available from the surgeon, patient information leaflets and reliable websites.
This means not being shy about asking questions and not agreeing to anything until it is fully understood.
The provision of detailed information about an individual’s medical history will assist the surgeon, as will information about any previous surgery.
It is important to inform the surgeon of all medications that are currently being consumed, including how much, how often and when they were last taken.
This should include all over-the-counter medications and supplements, such vitamins, creams, etc, as well as traditional medicines.
If one is unsure, assistance may be sought from one’s regular doctor or caregiver.
The medications can also be shown to the attending doctors.
Medication errors are not uncommon. As such, it is essential that medication information is communicated accurately and completely from admission to discharge from the hospital.
Surgical check list
It is important that all safety measures are undertaken, irrespective of whether the surgical procedure is minor or major.
The WHO surgical safety checklist, developed as part of its global patient safety programme, has been proven to keep patients safe during surgery.
It is a set of questions and reminders that surgeons and their surgical teams confirm with patients and each other before, during, and after the surgery.
There are three parts in the checklist – the briefing prior to administration of anaesthesia is completed with the patient, surgeon and surgical team; time-out is completed by the surgeon and surgical team before a cut is made in the patient’s body to facilitate the procedure (incision); and debriefing is completed by the surgeon and surgical team before the patient leaves the operating room.
The pre-anaesthesia briefing involves the patient being asked to confirm his/her name, date of birth, any medical conditions, previous surgeries, any allergies and medications, and any other relevant questions; all of which have to be answered fully.
Sometimes, the operative site is marked with a non-irritating skin marker. If the marker is on the wrong side of the body, the nursing and medical staff should be informed.
In short, clarifications should be sought if there is anything unclear or not understood.
The surgeon and surgical team should be asked if the WHO surgical safety checklist is being used.
If not, they should be asked what procedures are in place to ensure safe surgery.
After the surgery
Some patients are discharged on the same day as their surgery while others require hospitalisation.
In all instances, prior to discharge from the hospital, the patient should be breathing normally, able to eat and there is effective pain control.
The instructions on discharge should include which medications are safe to consume and when, including medications taken regularly; the level of activity that is safe; what food to eat; use of special equipment, e.g. crutches, nebulisers, etc; sexual activity; and any other instructions specific to the surgical procedure.
Infection(s) can affect the surgical incision site and other organs such as the lungs, urinary tract, gastrointestinal tract and so on.
The patient should be provided detailed instructions on how to take care of the incision site.
This will vary depending on the type of surgical procedure and the individual’s health situation.
It can be arranged electively or as an emergency.
The former is scheduled in advance by the patient and/or the doctor, and the latter is provided in trauma or acute conditions that present as an emergency.
Emergency surgery includes unplanned surgery for patients admitted in an emergency and unplanned surgery for patients awaiting elective surgery.
Although the objective of surgery is to save lives, surgery can also cause harm.
According to the World Health Organization (WHO), the risks of surgery include reported crude mortality rate after major surgery of 0.5%-5%; complications after inpatient operations in up to 25% of patients; and nearly half of all adverse events in hospitalised patients in advanced economies are related to surgical care.
At least half of the cases in which surgery led to harm are considered preventable.
The Health Ministry reported 1.039, 1.033 and 1.052 million surgical operations in its hospitals in 2012, 2013 and 2014 respectively.
There were one, one and five reports of “wrong” surgery in 2013, 2014 and 2015 respectively, of which three were wrong site surgery.
There were 13, 17 and 15 reports of unintended retention of foreign bodies in the Health Ministry, armed forces and private hospitals in 2013, 2014 and 2015 respectively, involving 11 hospitals each year. (Source: http://patientsafety.moh.gov.my/uploads/pscbook/pscbook.html; Accessed March 20)
Whilst hospitals and surgeons do their best to ensure that surgery is as safe as possible, there is much an individual patient can do for himself/herself.
Need for surgery
Discussions on the need for surgery should be carried out with the surgeon performing the procedure, and not a proxy, irrespective of whether it is another doctor or nurse.
Some of the following questions may help guide discussions.
• Why is surgery necessary?
• Are there alternatives to surgery, and if so, what are they?
• What are the risks of not having surgery?
• What does the surgical procedure involve?
• What are the expected benefits and risks?
• Is there a waiting list?
• What should be done if the condition improves or worsens while waiting for surgery?
• What are the anaesthetic risks?
• How can one prepare for surgery?
• What should one expect after surgery?
• What is pain after surgery like and how will it be managed?
• How long does it take to recover and what is the follow-up care needed?
• What should be done if one changes the mind about surgery, if rescheduling is requested, or if the condition improves and one feels that surgery is no longer needed?
The above questions are not exhaustive and individual patients and/or caregivers are advised to ask any and everything that comes to mind about the proposed surgical procedure before agreeing to it.
Knowledge about what to expect before, during and after surgery helps to ease patients’ fears and enables them to play an active role in their recovery.
Such information is available from the surgeon, patient information leaflets and reliable websites.
This means not being shy about asking questions and not agreeing to anything until it is fully understood.
The provision of detailed information about an individual’s medical history will assist the surgeon, as will information about any previous surgery.
It is important to inform the surgeon of all medications that are currently being consumed, including how much, how often and when they were last taken.
This should include all over-the-counter medications and supplements, such vitamins, creams, etc, as well as traditional medicines.
If one is unsure, assistance may be sought from one’s regular doctor or caregiver.
The medications can also be shown to the attending doctors.
Medication errors are not uncommon. As such, it is essential that medication information is communicated accurately and completely from admission to discharge from the hospital.
Surgical check list
It is important that all safety measures are undertaken, irrespective of whether the surgical procedure is minor or major.
The WHO surgical safety checklist, developed as part of its global patient safety programme, has been proven to keep patients safe during surgery.
It is a set of questions and reminders that surgeons and their surgical teams confirm with patients and each other before, during, and after the surgery.
There are three parts in the checklist – the briefing prior to administration of anaesthesia is completed with the patient, surgeon and surgical team; time-out is completed by the surgeon and surgical team before a cut is made in the patient’s body to facilitate the procedure (incision); and debriefing is completed by the surgeon and surgical team before the patient leaves the operating room.
The pre-anaesthesia briefing involves the patient being asked to confirm his/her name, date of birth, any medical conditions, previous surgeries, any allergies and medications, and any other relevant questions; all of which have to be answered fully.
Sometimes, the operative site is marked with a non-irritating skin marker. If the marker is on the wrong side of the body, the nursing and medical staff should be informed.
In short, clarifications should be sought if there is anything unclear or not understood.
The surgeon and surgical team should be asked if the WHO surgical safety checklist is being used.
If not, they should be asked what procedures are in place to ensure safe surgery.
After the surgery
Some patients are discharged on the same day as their surgery while others require hospitalisation.
In all instances, prior to discharge from the hospital, the patient should be breathing normally, able to eat and there is effective pain control.
The instructions on discharge should include which medications are safe to consume and when, including medications taken regularly; the level of activity that is safe; what food to eat; use of special equipment, e.g. crutches, nebulisers, etc; sexual activity; and any other instructions specific to the surgical procedure.
Infection(s) can affect the surgical incision site and other organs such as the lungs, urinary tract, gastrointestinal tract and so on.
The patient should be provided detailed instructions on how to take care of the incision site.
This will vary depending on the type of surgical procedure and the individual’s health situation.
Similar instructions should be given if there are infections in other organs.
A follow-up appointment is usually given.
If there are any questions, concerns or one feels unwell after discharge, there should be no hesitation in contacting the surgeon.
The above measures will assist surgeons and hospitals in ensuring that surgery is as safe as is possible
A follow-up appointment is usually given.
If there are any questions, concerns or one feels unwell after discharge, there should be no hesitation in contacting the surgeon.
The above measures will assist surgeons and hospitals in ensuring that surgery is as safe as is possible
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. The views expressed do not represent that of any organisation the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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