Safer surgery: Steps you can take

Chances are high that most of us will have a surgical procedure at some point during our lives. Estimates based on 2002 data in three states suggest Americans have a lifetime average of nine surgical procedures. In 2010 in the United States, there were an estimated 1.4 million inpatient procedures, ranging from childhood tonsillectomies, breast lumpectomies, and gallbladder removal to cataract surgeries, hernia repairs, and hip or knee replacements. And the rate of surgical procedures continues to rise. So it's valuable to know what you can do to make safer surgery and a successful outcome more likely.

How do I choose my surgeon?

If you are having elective (non-emergency) surgery, such as a knee or hip replacement, you have a choice of surgeons. Your primary care physician, best friend, or physician acquaintance may recommend a surgeon. Even with a strong referral, though, it's essential to ask questions. What do they like about that surgeon? Do they have any concerns you should be aware of?

When you meet with a surgeon, find out if he or she is board-certified. Board certification tells you that a doctor has gone beyond minimum licensing requirements to demonstrate expertise in their specialty. Ask how often the surgeon has done your procedure. Studies show that outcomes improve when a surgeon has more experience –– for example, in performing hip surgery.

Less obvious is whether you'll have your procedure at a hospital that does a high or low volume of surgeries. Research suggests it's safest to avoid having surgery at a hospital that does less than 10 per year of a given procedure. Outcomes are better for certain surgeries –– including orthopedic and cardiovascular procedures –– when performed in a hospital that does a high volume versus a low volume of surgeries. That's because high-volume hospitals have processes, resources, and an experienced team that can lower complication rates and respond quickly if a complication does occur.

How do I choose my procedure?

Most often, your surgery will seem straightforward –– for example, you are having your gallbladder out. However, increasingly people are faced with several choices for a given surgery. For example:

• Traditional "open" surgeries are one option.
• Noninvasive approaches using laparoscopy are increasingly common. Laparoscopy is done using a small scope and tools that require a few small incisions, instead of the larger incision needed for open surgery.
• Sometimes there is a choice between laparoscopic robotic surgery — that means a robotic device helps the surgeon control the tools –– and standard laparoscopic surgery.
• Also, surgery like a hip replacement can be done with an anterior (front), lateral (side), or posterior (rear) approach. The newer anterior approach for hip replacement may not be how your surgeon was originally trained.

Ask which approach your surgeon plans to take, why, and what the risks and benefits are for this approach versus alternative options. Also ask about his or her experience with the chosen approach. Think about whether you prefer an older surgeon with deep experience using a traditional procedure or a more recently trained surgeon using new advances.

Prior to your surgery, you will be asked to sign an informed consent: one for your surgery, and another for your anesthesia. This is your time to ask questions about risks and alternatives, if you haven't already done so.

If you feel inclined or your insurance requires this, get a second opinion. This is quite common. In fact, having a doctor discourage you from getting a second opinion is a red flag.

Are there steps I can take to help ensure safer surgery?

You can compare rates of surgical complications and infections at different hospitals on the Medicare website. You may also wish to check out your hospital's patient satisfaction scores. These scores are also associated with higher surgical quality.

Although an infection after surgery is a common complication, you can take steps to protect yourself.

• You will likely be asked to bathe or shower before surgery with plain or antimicrobial soap. This reduces the likelihood of skin bacteria entering the incision.
• Not only do you want your surgical team to be clean and sterile, it's also important that you, your visitors, and family members all wash hands rigorously. Be sure people do this when entering your room, after coughing, or before touching your skin following surgery.
• If you are having surgery after a long hospitalization or nursing home stay, you may be tested for colonization of a certain type of bacteria known as methicillin-resistant Staphylococcus aureus, or MRSA. If present, these bacteria can be eradicated prior to surgery.

Most importantly, always speak up if something doesn't look or feel right. Ask your family members to do the same. You and your family members are valuable members of your safety team.