You might not recognise it, but from the very first moment you set foot in your doctor’s office, your risk profile is being calculated.
Many health care decisions your doctor makes relate to risk. What is the future health risk of high blood pressure for this person?. Are any other compounding risk factors for heart attack present?. What is the risk of side effects from any medications used to treat the high blood pressure?. How severe are these side effects compared to the risk of leaving the high blood pressure untreated?. What is the risk the patient will not comply with my treatment recommendations?. What is the risk-benefit ratio for any of the treatment options we have available?. In the background, often instinctively, your doctor is constantly weighing up a myriad of questions such as these, making adjustments as more information becomes available.
Surgeons are perhaps the masters of risk assessment. They deal with evaluating risk every day, in almost every decision they make. For nearly every operation a surgeon conducts, the anticipated outcomes and risk profiles for that procedure have been well documented in the medical literature. Surgeons are mandated to monitor their own performance and perform peer reviewed audit of their outcomes. Surgeons evaluate and mitigate potentially life threatening risks on a daily basis.
When considering risk, a surgeon considers two main factors – Likelihood and Consequence. What are the chances of a complication occurring, and what is the significance if this complication were to arise?. These factors need to be weighed against the anticipated risk of other treatment options or the risk of the decision to not undertake any treatment at all. Sometimes these decisions are relatively easy. A minor operation to remove a cancerous skin lesion may pose very minimal procedural risk, but is likely to save life. In the back of the surgeon’s mind however, no matter how small the procedure or how slight the risk, your surgeon carries a healthy degree of respect of risk. Every surgeon has seen devastating complications, even from so called minor procedures.
The risk of surgical complications is significantly influenced by the person’s underlying health. People with diabetes have a far higher risk of wound infections when undertaking foot operations. Smokers have a higher risk of developing pneumonia after general anaesthesia. The risk of inadequate pain control after surgery is higher in people who have opiate addiction. Sometimes the underlying heath concern cannot be easily changed or reversed, and we accept that the surgical risk is just going to be higher in some people. Diabetes represents a risk, but if the control is optimised then this is as best as we can get. Whilst the risk may be higher, we accept this as being the case for this particular person, and we take this into consideration when deciding if surgical treatment is the best course of action.
In optimising your health prior to surgery to improve your chances of a successful outcome, surgeons are most interested in Reversible Risk Factors. Reversible Risk Factors are health problems that increase the likelihood of a surgical complications but can be improved prior to your procedure. There are a wide variety of health concerns that fall into this category. Obesity, smoking, unregulated diabetes, poorly controlled mental health disorders, substance addition, unstable angina, skin disorders and muscular deconditioning are common examples of health problems that may be optimised prior to undertaking surgery to reduce the risk of complications or adverse outcomes. Your surgeon may therefore recommend assessment or treatment for these health conditions prior to undertaking your operation.
Why are Reversible Risk Factors important?. Whist optimising health does not eliminate the risk of surgical complications, both the likelihood and consequence of having a poor outcome may be significantly reduced. In some ways, surgery is like poker. Even if you play poker well, if you are holding terrible cards then chances of obtaining a positive outcome are significantly reduced. You increase your chances of success if your hold a stronger hand. Even in situations where risk is unavoidable, good decision making, optimal preparation and risk mitigation counts. Good surgeons are both paranoid and meticulous for good reason.
For many Reversible Risk Factors, patients themselves play an important role. Nutrition and weight management planning, smoking cessation, physical conditioning programs and mental health strategies may be of significant benefit to some people in paving the pathway to a streamlined post-surgical recovery. Obtaining good outcomes from surgery not only depends on your choice of surgeon. The patient also plays an influential part in their own outcomes and ultimately shares some of the responsibility for their own health, even when undertaking an operation.
Many people with Reversible Risk Factors benefit from professional assistance in optimising their health prior to surgery. There are many health services available to patients who are motivated to obtain the best results from their operation. Talk to your general practitioner. Visit a dietitian. Seek assistance with cigarette reduction. Consistently, outcomes are better and more is achieved with a coordinated management plan delivered with the assistance with a health care professional trained to manage the condition of interest.
No matter when your surgery is planned, preparation starts now. Identify health concerns or behaviours that might influence the outcomes of your procedure. Seek advice. Assign priority. Play an active role in your own health, because ultimately it will be you who will own the outcome.
This information has been written by A/Prof Patrick Weinrauch for the purposes of patient education. The details provided are of general nature only and do not substitute for professional recommendations based an individual clinical assessment. ©
A/Prof Patrick Weinrauch is an Orthopaedic Surgeon and the Director of Recovery Medical. Patrick, after repeatedly observing that better results were reliably obtained in those patients who were more optimally prepared for surgery, developed Recovery Medical to assist people in their preparation and post–surgical recovery.