Surgery

Fitness for Surgery or Factors Affecting Surgical Decision



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Surgery is a reconstruction, removal, implantation or exploration procedure done with the intention to relieve, cure or diagnose certain problems encountered in the body.

The usual scenario is a patient visiting the general practitioner or the family doctor for advice for certain condition and the primary care doctor referring the patient to an appropriate consultant. The consultant might be a surgeon in case the doctor's best opinion would be such.

As soon as the patient meets the consultant, he will evaluate to first confirm a diagnosis and then to assess the patients fitness for surgery. I will briefly describe certain factors needing attention and the management process in making the patients fit for surgery.

Age

When a very elderly patient undergo surgery, the anesthetist and the surgeon will evaluate the patient to the maximum possible level and even then will only continue with the surgical option if that means saving the patient's life and improve the quality of life.

The problems associated with age would be the patients ability to withstand the general anesthesia and the trauma following a major surgery.

It is a fact that most elderly patients will be having medical problems associated with heart, kidneys, liver..etc. As these organs are vital and should function well in withstanding the surgical procedures, especially major surgeries, it is a must to further evaluate these patients with required investigations.

Medical problems:

When a patient with existing medical problems undergoes surgery, the surgeons and the anesthetists are on the utmost alert. That is because these conditions can affect the recovery process or it can complicate the surgical procedure.

Disorders such as diabetes will affect the wound healing process as well as make the patients more prone to get post operative infections. As the controlling of sugar levels becomes difficult following surgery, a proper evaluation and control of the sugar levels prior to the surgery is a must.

Hypertension is another dreaded condition that requires meticulous attention. Pressure control as well as continuous monitoring would overcome the risks in these patients. Otherwise they can go into heart failure and bleeding following major surgical procedures.

Functions of the kidneys are vital in surgical procedures, specially major surgeries. If the function is poor, the patients have to be monitored for hydration and be careful in giving overdose of saline or any other fluids that will make them fluid overload.

Wheezing is another complication that is assessed well in advanced for such patients. The anesthetists need to know the possibility of going into a wheezing attack and expect the worse and be prepared.

Fever and infections would also possess a danger in proceeding with a surgery as it would complicate the outcome and will delay the healing process. It will require more stringent antibiotics to be administered or even the postponement of the surgery till the patient is relieved of the infection.

Necessity:

Although the patients sometimes consider that a surgery is required in a certain condition, the surgeons want go into a sudden decision without assessing the pros and cons. For instance, a patient with extensive spread of a cancer which manifest as a partial obstruction in the bowel, would be assessed on following basis before the surgery. Will the patients chances of survival increase with the surgery? Will he be able to have a quality life thereafter? By doing the surgery will the agony of suffering be extended? What are the patient's own wishes for refusal?..etc.

In major surgeries, the decision will depend on the absolute necessity and fitness of the patient.

Alternatives:

If an alternative, non surgical procedure is available, then the surgeons might decide to treat on that basis rather than going ahead with a major surgical procedure.

Cost:

Even though it seems unethical to decide on the surgical requirement based on the cost incurred and the ability to pay, the world is not so kind to everyone.

Some surgical procedures, being costly, are deprived to individuals who need it most and alternatives are tried instead. Some developing countries face this burden due to non availability of funds to treat these patients thus necessitating to be in a long list to get the surgeries done.

Patient's wish:

The patient's wish, if he is able to give informed consent, is another important factor in deciding to go for surgical treatment.

Apart from these there are numerous factors affecting the decision to undergo surgery on a individual and based on that, the surgical procedures can be postponed till these are corrected or abandoned all together for alternative treatment.

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