Definition and Overview

Surgery consultation, which is an essential part of any surgical procedure, involves making an assessment as to whether the patient is fit to undergo surgery and if the benefits of the procedure outweigh the risk. It also involves monitoring the patient’s recovery and progress after the procedure, ensuring that there are no complications or if there are, ensuring that they are managed and addressed as soon as possible.

Surgery is a branch of medicine that deals with the treatment, management, and assessment of a wide range of medical conditions, such as cancer and heart transplant, among others. Surgery can also be performed for aesthetic purposes (example: facelift, breast reduction, etc.). It typically involves using local or general anesthesia and making excisions using hand tools and more advanced instruments to access the affected part and perform any action that is needed to achieve the desired result.

According to the data of Centers for Disease Control and Prevention (CDC), more than 50 million inpatient surgeries are carried out every year. These statistics are different from figures of outpatient surgeries, or procedures that do not need any hospital stay as the patients can go back to their homes or stay in a hotel where they can recuperate.

The goals of surgery consultation are to:

  • Ensure the patient is not subjected to unnecessary pain, discomfort, and recovery process
  • Suggest the most suitable surgical technique or procedure to treat the disease, reduce the symptoms, or manage the condition
  • Make the patient fully understand the potential risks or complications of the procedure
  • Outline an individualized surgical plan that can be followed through
  • Keep track of the patient’s progress and recovery, especially during the first 24 to 48 hours after the surgical procedure

Doctors who specialize in surgical procedures are called surgeons, and their education and training in the field is comprehensive. Aside from 4 years in undergraduate school and another 4 years in medical school, they also participate in a residency program that lasts for at least 2 years. Surgeons can then subspecialize in different areas such as the nervous system, heart, digestive system, or orthopedics, among others. The subspecialty training may require an additional 6 years of training, which allows them to work closely with senior surgeons.

Who Should Undergo and Expected Results

Patients go through surgery consultation when they:

  • Are referred by their general doctors or other specialists – General doctors and other specialists such as cardiologists, neurologists, or nephrologists have in-depth training in their respective fields, but more often than not, they don’t possess the required surgical skill. Thus, they work closely with surgeons, with whom they refer their patients to. The surgeons then decide whether the patient requires surgery.

  • Are meant for surgery – If the surgeons determine the patients are likely candidates for surgery, they conduct more consultations wherein they perform or interpret test results, plan the surgical procedure (including the date of the surgery), recovery program, etc.

  • Have completed surgery – Consultations are also carried out as soon as the surgery has been completed. At this point, the surgeon’s concern is to ensure that the patient responded well to the procedure and to verify whether or not there are complications.

  • Develop complications to procedures – Not all surgical complications occur quickly. In some cases, it takes days or even years for them to be discovered. Patients who develop such are encouraged to set an appointment with their surgeon, so the complications are addressed as soon as possible, preventing them from getting worse.

  • In an emergency – Hospitals, especially those with trauma units, have in-house or stand-by surgeons for patients who need emergency care. Consultations are quick as time is of the essence in these cases.

The expected results of the surgery depend on the goal of the consultation. The patients may:

  • Learn whether they are fit for surgery or, if not, understand the reasons why and determine other possible treatment options
  • Identify the risks and possible results of the surgery so they can decide for themselves whether to proceed with it or not. In the case of minors (paediatrics), the decision rests with the adult, who is either a parent or a guardian.
  • Obtain a better picture and prognosis of the disease based on the additional tests
  • Ensure patients are prepared physically, mentally, and even spiritually for the surgery
  • Determine the best steps to take during the post-operative care

How Does the Procedure Work?

Surgeries are either planned or emergency. In an emergency, more often than not, the procedure is performed alongside certain tests, which can be used to determine the extent of the disease or injury.

Most of the surgical consultations, however, are planned. This means the patient has been referred by a doctor or a specialist following the results of initial tests. Patients then set appointments with the recommended or their chosen surgeon.

During the initial pre-operative consultation, the surgeon asks a series of questions to know the main concern of the patient, from the disease to the fears or discomfort about surgeries. The surgeon then looks into the results of the exams, which should have been forwarded before the consultation. If the tests are not enough to make a decision, the surgeon may request for more tests, which will then be evaluated and discussed during the next consultation.

In the next consultation, the surgeon can then inform the patient if he or she is eligible for surgery. Not all diseases or conditions can be managed by surgery, especially if the risks or complications outweigh the benefits. If the patient is eligible, the surgeon will discuss:

  • The best date to perform the surgery
  • The technique and anaesthesia to be used
  • Pre-operative procedures including possible medications to take
  • Whether it’s an outpatient or inpatient surgery
  • Risks and complications
  • Post-operative care and management

Patients are always welcome to ask questions or voice their concerns during surgery consultation.

The surgeon may perform another consultation a day before the actual schedule of the surgery. The next consultations will be carried out after the procedure. The surgeon should closely monitor the progress of the patient until he or she has achieved full recovery.

Possible Risks and Complications

A surgery consultation doesn’t in any way guarantee the elimination of risks and complications. However, one of the primary objectives of the consultation is to reduce and/or mitigate these risks, which can include bleeding, infection, and organ failure. Patients and surgeons should work hand in hand to ensure the patient’s safety all throughout the surgical process.

References:

  • Beauchamp RD, Higgins MS. Perioperative patient safety. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 10.
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