Book Publications The Columbia Presbyterian Guide to Surgery

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What are the risks associated with the surgery itself?

The type and level of risks vary widely, depending on the operation and your medical condition.

Fear is a normal response to these risks, but you can find out whether that specific fear is irrational or not. Ask yourself, "What am I really afraid of if I have an operation?" Once you pinpoint your fears, you can express them to your surgeon. Do not feel embarrassed. Many people are afraid of anesthesia or pain. Others fear being out of work or having a scar. Doctors have heard them all and would much prefer to discuss your fears than allow them to prevent you from having surgery or to make you miserable.

Risks of surgery include:

Mortality. Yes, you can die in surgery. The risk ranges from virtually 0 to 50 percent and up. Highly invasive surgery creates a greater likelihood of something happening that could threaten your life. In an operation to replace a heart valve, the risk of dying in surgery is about 2 percent. In an operation for breast cancer where the surgery is basically on the body's surface and there is very low chance of bleeding and infection, there is much less risk.

As a result of going through an operation, you could suffer a heart attack or stroke, have bleeding, get an infection or pneumonia, have kidney or liver failure. But the chance in your case may be so minimal that it's not a factor in your decision. With another set of medical facts, the risks may have to be weighed more.

Concerns about mortality are real, but there is a way to deal with them: bring them out into the open. Allow yourself to get relief from knowing the facts. You may stay up nights worrying about anesthesia and when you finally decide to speak up, the doctor says, "Don't worry about it. There's a greater likelihood of being killed in a car accident on the highway." That might help you put your fear into perspective: why obsess over anesthesia when every day you drive to work on the highway without feeling any undue fear that this is the end?

Pain. The amount of pain you may experience is totally variable and depends on the operation. You can't assume how much pain there will be based on the type of operation. In the aftermath of some types of heart surgery, there is less pain than after an operation for a dislocated shoulder. If you're concerned about pain and how to relieve it, speak up. Don't go into surgery dreading pain or worrying that you sound weak if you insist on having appropriate measures to relieve it.

There are many strategies today for pain relief. The spectrum of drugs is remarkable and continuing to grow. New techniques have made it possible for some patients to control the administration of drugs for their pain. Ask your doctor to discuss whether you are a candidate for pain relief without drugs, including self-hypnosis, physical therapy, deep-breathing techniques, and massage.

Everyone has a different threshold of pain and a different way of reacting to it. One person has a headache and keeps on functioning; another takes medication and goes to bed. How one experiences pain is an individual response, so don't try to compare yourself to some mystical "normal" pain threshold. Rather, be aware of how you react to pain and expect appropriate relief from your experience of it.

Fatigue. This is a universal complication of surgery. Studies have shown that any one of the components of surgery—anesthesia, bed rest, lack of food—can bring on fatigue. When you put them all together, it's no surprise you're knocked out.

Even in minimally invasive surgery, recovery can take a long time. In many cases, your medical condition debilitates you to begin with, which will, in all likelihood, delay your rate of recovery after surgery.

Often patients feel okay in the direct aftermath of surgery, only to feel worse in about three days. Then they gradually start to improve. If you know this in advance, you can understand the recovery phenomenon and not be afraid that something is wrong when normal post-surgical fatigue sets in.

Other complications from surgery include: infection; bleeding; stroke; heart attack; allergic reaction, nausea, and vomiting from anesthesia; and reopening of the wound. Your surgeon should discuss all the risks frankly with you. Find out what may cause a problem during or after surgery and whether it applies to your situation. As a quick reference, read about a specific surgical procedure in Part Three of this book, pages 161–313.

In evaluating whether to have surgery, consider what's worse for you—the risks associated with surgery or those associated with a disease or injury left untreated?

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