Not Good News

[orthodoc]

Post-surgical complications aren't always a matter of surgeons fucking up. Sometimes - but not always. For example, if you're a 380 lb 5'5" sedentary Type 2 diabetic smoker who needs a cholecystectomy (gallbladder out), what do you think your chances are of post-op complications? Pretty damned high. You'll need an open procedure rather than a lap, for a start, because you have too much fat for the surgeon to see anything using a laparoscope. Not the surgeon's fault that you're now having a higher-risk procedure with more tissue trauma, infection potential, and longer recovery time. Then, you've given yourself a double-whammy with your diabetes and your smoking in that you won't heal well. You'll be at high risk of pulmonary complications, blood clots with pulmonary emboli, and dehiscence - the wound simply doesn't heal together and falls apart within a few days as the weight of your fat-laden tissue pulls against it. You'll be at much higher risk of infection - your diabetes and your smoking both suppress your immune system. You'll be harder to mobilize, more likely to need extensive pain meds that make you dopy and harder to get moving, and again your risk of blood clots shoots way up. Your gut will take longer to start moving again.

None of these things are related to surgical technique, nor even to post-op care. They are all squarely the responsibility of the patient in coming to surgery with huge lifestyle-related health issues that have made it almost impossible to have surgery without complications.

CMS is taking care of that, however. Are people being strongly encouraged to eat and live healthier? Haha, you jest. No, the CMS solution is that surgeons and hospitals won't get paid for the surgery if complications occur. They are the ones who'll be punished if people don't get off their butts, exercise, eat right, stop smoking, and get healthy prior to having surgical procedures.

[xoxoxoBruce]

Ortho, calm down. Now breathe.

Effective methods for reducing surgical complications have been identified. However, hospitals have been slow to implement them.

They're talking about business decisions, infection prevention being a good place to start.

[footfootfoot]

Originally Posted by orthodoc

Post-surgical complications aren't always a matter of surgeons fucking up. Sometimes - but not always. For example, if you're a 380 lb 5'5" sedentary Type 2 diabetic smoker who needs a cholecystectomy (gallbladder out), what do you think your chances are of post-op complications? Pretty damned high. You'll need an open procedure rather than a lap, for a start, because you have too much fat for the surgeon to see anything using a laparoscope. Not the surgeon's fault that you're now having a higher-risk procedure with more tissue trauma, infection potential, and longer recovery time. Then, you've given yourself a double-whammy with your diabetes and your smoking in that you won't heal well. You'll be at high risk of pulmonary complications, blood clots with pulmonary emboli, and dehiscence - the wound simply doesn't heal together and falls apart within a few days as the weight of your fat-laden tissue pulls against it. You'll be at much higher risk of infection - your diabetes and your smoking both suppress your immune system. You'll be harder to mobilize, more likely to need extensive pain meds that make you dopy and harder to get moving, and again your risk of blood clots shoots way up. Your gut will take longer to start moving again.

None of these things are related to surgical technique, nor even to post-op care. They are all squarely the responsibility of the patient in coming to surgery with huge lifestyle-related health issues that have made it almost impossible to have surgery without complications.

CMS is taking care of that, however. Are people being strongly encouraged to eat and live healthier? Haha, you jest. No, the CMS solution is that surgeons and hospitals won't get paid for the surgery if complications occur. They are the ones who'll be punished if people don't get off their butts, exercise, eat right, stop smoking, and get healthy prior to having surgical procedures.

Pollyanna