Contemplating Surgery?

Posted on April 18, 2023

I admit to being surprised by the sometimes response of clients and family members when they are presented with next steps that involve stress to the body. Recently, a friend I care deeply about was informed by her doctor that she needed to have surgery. Her response was, “Are you sure?” To which she replied in the affirmative. To which she said, “OK, when?” No other questions. My response – “whoa, time out, let’s slow this train down!”

Surgery – minor or major - produces a stress response on the body, described as “. . . a complex neuroendocrine-metabolic and inflammatory-immune process.”[i] In other words, it is an assault on the body.

What this means is many different systems and process within the body are affected. During surgery, our bodies respond to the stress of the procedure by releasing various hormones and other molecules that can affect blood pressure, heart rate, breathing rate and other functions.

It can also lead to inflammation and immune system activation which contributes to pain, swelling, and other side effects of surgery. These responses are designed to help the body cope with the stress of the surgery and to promote healing and recovery.

The outcome of someone who is younger and healthier is going to respond better than another person who is middle-aged or older. Keep in mind 35.3% of all inpatient procedures and 32.2% of all outpatient procedures in the United States are performed on adults over 65.[ii]

Advocate: What to Think about and What to Ask and Consider

Speaking with a doctor, any doctor can be overwhelming. More so when the subject is about surgery. Sometimes even the most well-meaning doctor can present too much information, too quickly and in complex terms.

People just tend to nod their heads and listen -- but leave feeling confused and no better informed about their own health and care! Remind whoever you are speaking to that you didn’t go to medical school.

Suggestions about what to say if your doctor seems to be “speaking Greek” to you:

a) I need you to “dummy” this down so that I can absorb and understand what you are telling me.

b) Why is this surgery necessary and what are the potential benefits and risks?

c) Should I be worried about this?

Any surgical procedure should not be taken lightly. If you see a surgeon, the surgeon will cut. Studies have shown that the more patients know about a recommended surgery, the more likely they are to find another treatment that works for them.

Never hesitate to seek 2nd or 3rd opinions

This can help confirm the diagnosis and treatment plan, and provide you with more information to make an informed decision.

Don’t let anyone tell you that any surgery is “routine.”

There are often good rewards for having surgery, but there are always risks.

Good Questions to ask:

a) What is the name of the surgery? (Medical and common name?)

b) How many of these surgeries have you personally done? (Don’t settle for any fewer than hundreds, ideally thousands.)

c) What are the alternatives to surgery? What are some other choices? What will happen if the surgery is not performed? What other treatment options are available?

d) Please explain the procedure: How will it be performed, how long will it take, what anesthesia will be used? What will the recovery process be like?

e) Who would perform the operation? Who would assist? How many surgeries have they done? Would students or residents be present? What would they do in the surgery?

f) Does the surgery team use a checklist?

g) Does the surgery team take a time-out in the operating room before surgery?

h) Is everyone on your surgery team Board Certified – including the anesthesiologist?

i) What steps are taken to prevent infection before, during and following surgery? Preventing infection is everyone’s job. In the hospital or outpatient surgery center, remind everyone, not to come near your loved one - unless they have washed their hands or used the alcohol-based cleanser. Don’t take their word for it – you want to see them WASH THEIR HANDS.

Remember ultimately the decision to have surgery is yours. It’s important to understand the reasons behind the recommendation for surgery and to be well informed before making any decisions - based on your own unique circumstances, preferences, and values.

One final thought. Once you or your loved one is home and recovered, recognize and celebrate healthcare professionals who are committed to safe surgical practices. Write letters of appreciation to your surgeons and other healthcare providers. Share positive reviews online.

[i] B. Cusack∗ and D.J. Buggy. Anesthesia, analgesia, and the surgical stress response.
07/21/2020. National Library of Medicine. bit.ly/3A8nmel
[ii] Deiner S, Westlake B, Dutton RP. Patterns of Surgical Care and Complications in Elderly Adults. J Am Geriatr Soc. 2014;62(5):829-835. doi:10.1111/jgs.12794. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/24731176/