When You’re Considering Surgery: What You Should Know

The chances are good that one day you will need surgery. The surgery may be a simple procedure, keeping you in the hospital for only a short time, or it may be complex, requiring a lengthy stay. Either way, it will most likely be elective surgery — that is, surgery that is planned rather than done on an emergency basis. You will have time to research the procedure, choose a good surgeon, and get a second opinion if you need to. Millions of Americans have surgery every year. Among the most common procedures are some related to arthritis, such as a knee or hip replacement, removal of a ruptured vertebral disk, or a spinal fusion (fusion of two or more vertebrae of the spine). Other common operations include appendectomy (removal of the appendix), hysterectomy (removal of the uterus and sometimes the cervix), cataract surgery, prostatectomy (removal of part or all of the prostate), cholecystectomy (removal of the gallbladder), and hernia repair. This article explores what you need to know when you’re considering surgery and the risks and benefits that come with it.

Considering surgery and finding the right surgeon

Often it is a person’s primary care physician who first recommends surgery. If so, the physician may be able to recommend a specific surgeon who can perform the procedure. You can also ask friends, family members, and coworkers for the names of surgeons they have used for similar procedures. You will also want to check with your insurance company or Medicare for any restrictions as to which surgeon and which hospital you are able to use.

Make sure any surgeon you are considering is qualified and is experienced in doing the procedure you’re going to have. Find out whether the surgeon is “board certified” in surgery, meaning that he or she has had special training and has passed exams administered by a national board of surgeons. The surgeon’s certification should be from a surgical board that is approved by the American Board of Medical Specialties (ABMS). You may be able to find a reference book titled The Official ABMS Directory of Board Certified Medical Specialties at your local public library or through state and county medical associations. The book contains brief information about each surgeon’s medical education and training. You can also find out a surgeon’s board certification status by visiting the ABMS Website or by calling (866) ASK-ABMS (275-2267).

If the surgeon has the letters “FACS” after his or her name, he or she is a Fellow of the American College of Surgeons and has passed another review of surgical skills by other surgeons. For information about how to find Fellows of the American College of Surgeons in your area, see “For More Information.”

It is safest to use a surgeon who has had a lot of experience in the particular surgical procedure you’re considering because there is a learning curve to these procedures. Generally speaking, the more procedures a surgeon has performed, the more skillful he or she becomes at carrying out that procedure. It is completely appropriate to ask a surgeon about his or her recent track record of successes and complications with this operation. If this makes you uncomfortable, you can always discuss the surgeon’s qualifications with your primary care doctor.

However you go about finding a surgeon, you need to be clear on a few things before deciding whether to have surgery. Here are the most important considerations.

Understand Why You Need Surgery and How the Surgery Will Be Done

First of all, if your doctor is recommending surgery, it’s important to understand why. Is it to improve quality of life? (Examples are joint replacements and cataract surgery.) Is it to uncover the underlying cause of a problem? Or is it to prolong your life? (An example is angioplasty.) Make sure your surgeon fully explains the reason for the procedure, how it will fix the problem, and what the consequences are of not having the surgery.

You also want to know, in detail, how the surgery is done. What are the steps involved? In some cases, the surgeon may be able to draw a diagram of what is going to be done.

You should also know whether there is more than one way to do the operation. For example, a number of procedures can now be done laparoscopically. In laparoscopic surgery, the surgeon makes several small incisions instead of one large one and inserts a laparoscope through one of the incisions and tiny surgical tools through the others. The laparoscope — a tiny tube with a camera on its end — sends images to a video monitor, and the surgeon uses those images to guide him or her through the surgery. Or to use another example, knee replacements may sometimes be done using a smaller-than-usual incision and specially sized surgical instruments, and/or the surgeon may use new techniques that involve less cutting of tendons. These minimally invasive surgical techniques can mean shorter recovery times, but they aren’t always appropriate. If there is more than one way to do the surgery you’re contemplating, find out why your surgeon has chosen one procedure over another.

Find out where the surgery will be performed. Will it be in a hospital, a doctor’s office, a surgical center, or a day surgery unit of a hospital? Outpatient surgery — that is, surgery not performed in a hospital — does not require you to stay overnight and may therefore be less expensive.

Ask about what kind of anesthesia will be used and why that type is preferred for the procedure. There are three basic types of anesthesia: local, regional, and general. Local anesthesia involves numbing a part of the body for only a short period of time — an example is the use of Novocain for dental procedures. Regional anesthesia involves numbing an entire region of the body for a few hours. In most cases of regional anesthesia, the individual is awake during the entire procedure, though in some cases sedative drugs are also used and the person remains asleep. One type of regional anesthesia sometimes used is epidural anesthesia, which involves running medicine through a catheter (a thin plastic tube) into an area of the spine, thereby numbing nerves that connect to the lower half of the body. General anesthesia involves numbing the entire body and putting the individual to sleep for the duration of the procedure.

Find out whether there are any alternatives to surgery. In some cases, a medical condition can be treated just as well — if not better — by diet, exercise, and medicine. In other cases, watchful waiting, in which you and your doctor wait to see whether the problem gets better or worse over time, is the best option. If the problem gets better, the surgery may be delayed or not performed at all.

How Much Will Surgery Cost?

Find out how much the operation is going to cost you. Even if you have health insurance, you may still have to foot some of the bill yourself. What is the surgeon’s fee and what does that fee cover? (Surgical fees often include postoperative visits with the surgeon.) The hospital and other doctors (such as the anesthesiologist) will also bill you separately for your care. Once you have found out all these costs, and before you have surgery, call your health insurance company and ask how much of the cost the insurance pays and what portion you will have to pay. In some cases, the amount of coverage will depend on your choice of surgeon and hospital. If you’re covered by Medicare or Medicaid, call (800) MEDICARE (633-4227) to inquire about how much you’ll have to pay for your surgery.

Benefits versus risks of surgery

You’ll want to know the benefits and risks of the procedure. First, what do you stand to gain? If you’re having a hip replaced, for example, you’ll gain relief from pain and the ability to walk again with relative ease. And in all cases, find out how long the benefits will last, as not every benefit will last a lifetime. (For example, most hip replacements last for 20 years or more, but over half of all ankle replacements fail within 5 to 10 years after surgery.) It is also important to be realistic about the surgery’s benefits so you won’t be disappointed with the results. If you are having a knee replacement, for example, don’t expect that having a new knee will mean you’ll be able to participate in all types of physical activity — to avoid stressing your new joint, your surgeon will most likely recommend that you avoid certain more vigorous activities, such as high-impact aerobics and singles tennis.

As for risks — all surgery carries risks. Knowing these risks helps you to weigh them against the potential benefits. Make sure you find out about all of the possible complications of the surgery itself. These include infection, excessive bleeding, accidental injury, or a bad reaction to the anesthesia. The surgeon can also tell you what to expect in the hours and days after the procedure, such as swelling and soreness around the incision.

Recovering from Surgery: What to Expect

Find out how long it will take to recover from the surgery. How long will you need to remain in the hospital? When can you return to your regular daily activities? When can you return to work? What sort of rehabilitation and physical therapy will be required? Joint replacement surgery, for example, generally requires a considerable amount of physical therapy to restore range-of-motion in the joint.

Further, ask about how much pain to expect, how long it is expected to last, and how it will be controlled. Typically, mild to moderate postsurgical pain, as might accompany dental procedures or removal of small skin lesions, is treated with nonsteroidal anti-inflammatory drugs (NSAIDs). Moderate to severe pain, as might occur with more involved procedures such as abdominal or back surgery, is treated with oral or injected opioids such as morphine or oxycodone. Sometimes epidural anesthesia is used in the hospital to control pain after certain types of surgery, including hip or knee replacement surgery.

Get a second opinion

If you have any doubts as to whether having the surgery is a good idea, get a second opinion. To do this, you can ask your surgeon to refer you to another surgeon. If you do not feel comfortable with this, consider asking your primary care physician for the name of another surgeon. Arrange to get your medical files from your first surgeon or have him or her send them directly to the second surgeon.

Many health insurance companies require that you get a second opinion before undergoing certain procedures. Even if your health insurance company doesn’t require a second opinion, it may be willing to pay for one. Check with your health insurance company or your employee benefits office to see whether a second opinion is covered. If you are covered by Original Medicare, Part B will generally pay 80% of the approved amount for a second opinion. (And if the second opinion does not agree with the first, Medicare will pay 80% of the approved amount for a third opinion.)

If you are in a Medicare Managed Care Plan, your plan may pay for a second opinion if you first get a referral from your primary care physician. (Talk with your Medicare plan representative to find out if and how much of a second opinion is covered under your plan.) If you have Medicaid, call (800) MEDICARE (633-4227) to find out whether it will cover a second opinion.

The decision about whether to have surgery can be a daunting one, because there are so many risks and benefits to weigh. But remember: Knowledge is power. The best way to feel comfortable with your decision is to find out as much as you can about the procedure and the surgeon performing it.

Robert Dinsmoor is a medical writer and editor based in Massachusetts.

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