Definition and Overview
Paediatric cardiothoracic surgery consultation is a visit to the surgeon to discuss a surgical procedure that will be performed on a young patient with a medical condition that affects the thoracic region such as the lungs and the heart.
Paediatric surgery is a specialised field as children and young adults (individuals who are 21 years old and below) have different health needs and concerns when compared to adults. In the case of cardiothoracic issues, genetic conditions are more common among children than older people. Also, although children generally recover faster, their degree of understanding of the illness can be limited. A cardiothoracic surgery consultation pays close attention to these special needs, more so as the patient is about to undergo a delicate and potentially life-threatening procedure.
Who Should Undergo and Expected Results
A consultation with a cardiothoracic surgeon is necessary when:
The child is diagnosed with a cardiothoracic condition – Not all types of cardiothoracic conditions require surgery. In other cases, medications and other treatment methods work. However, if surgery is the only possible way to treat the condition, the surgeon will schedule a consultation with the patient and his parents or legal guardians to discuss the procedure.
The parents need a second opinion – Surgery, especially those that involve children, can be daunting for parents, and it’s normal for them to be worried about the possible risks and complications. Most parents seek a second or even third opinion of another expert, who may provide a different diagnosis or treatment.
The doctor needs to prepare the patient and the parents for surgery – A consultation happens during the pre-surgery stage. This is basically a time when both the child and the parents are prepared for the upcoming procedure. Special preparations are needed to ensure the risks and complications that often occur during and after surgery are minimised. These include a meeting with the anaesthesiologist, giving out fasting guidelines, and conducting various tests.
A consultation is helpful in many ways. One, it helps establish a relationship between the surgeon and the parents, as well as the child, which can play a pivotal role not only in the treatment but also in the short- and long-term recovery of the patient.
How Does the Procedure Work?
A consultation occurs once a doctor refers a patient to a specialist. In this situation, the paediatrician refers a patient to a cardiothoracic surgeon who is trained to diagnose and treat more complex health issues that affect the lungs and the heart.
The parents set up an appointment with a cardiothoracic surgeon recommended by the paediatrician or the insurance company. The hospital coordinator may also make a suggestion or the parents can look for their own specialist.
Unless the condition is urgent, the first consultation is scheduled. During the meeting, the parents are encouraged to bring along their child as the surgeon may need to perform a thorough physical exam and other tests. The surgeon will review all the medical records, which are typically forwarded by the paediatrician to the surgeon’s office before the consultation.
Depending on what the surgeon can conclude from the medical records and the initial exam, he may request for more tests, which can help in making a more comprehensive diagnosis and surgery plan.
In the next visit, it’s expected that the surgery plan is discussed. Surgery is often divided into three phases, namely, pre-surgery, surgery, and post-surgery or after care. The surgeon also needs to talk about follow-up consultations, which are scheduled after discharge to ensure that no complications have arisen or if they have, they are promptly addressed. The doctor will then introduce the parents to other members of the surgery team like the anaesthesiologist, who will most likely to request for a consultation as well.
At any time of the consultation, the parents should ask questions about the surgery, including but not limited to costs, risks and complications, post-recovery expectations, and surgical technique to be used.
The length of time for each consultation varies. In the beginning, it may be 40 minutes to an hour.
Possible Risks and Complications
As mentioned, a consultation is a good time to build a relationship with the doctor. Unfortunately, it doesn’t happen all the time, which means it may become an unpleasant and sometimes traumatic experience for everyone involved.
Also, a consultation can be bothersome and scary for children, even for toddlers. They may not be able to articulate properly their fear and concerns, but they can feel the nervousness from the parents. Their own perception on these visits can also affect the outcomes.
Chung DH. Paediatric surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 13.
Neumayer L, Vargo D. Principles of preoperative and operative surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 11.