To Have or Not To Have Surgery..

How To Decide Whether or Not To Have Surgery

Steve A. Mora MD

 

One of the hardest decisions patients have to make in my office is whether or not to proceed with surgery.

 

Sometimes the decision is easy but often times it’s a hard thing to do especially when facing “elective” surgery. Elective surgery basically means that surgery is not 100% necessary.  Another way to look at it is that the surgery is not to save a life or extend it necessarily.  Elective surgery is usually done to improve a patient’s function by reducing their pain or improving strength.

 

Some elective surgery can be more pressing than others.  For example if a patient has profound weakness of their shoulder because of a tear or if they have a fracture, it is more important to move forward with surgery.   Regardless it is still called “elective” surgery, albeit, some patients would consider it almost mandator.

 

Sometimes a patient will make it easy for themselves by simply saying “I will not have surgery under any circumstance”. Those ate the easy patients because I know that they have decided and that’s the end of the story.  How about the patient who wants to be better, are reasonable about taking on a small amount of surgical risk but need help making the decision.   How do I help these patients?

 

When a patient is faced with this decision I guide them by simplifying and breaking down the decision tree.  There are so many variables to consider therefore it makes it much easier if it is broken down into a 3 basic components.

 

This is the typical dialogue I have with my patients.

 

1.  Is the surgical procedure one of High, Medium, or Low risk.  Basically what is the likelihood of having a terrible complication? Most of the surgery we do go well.  The likelihood of a complication is very very low.  There are a few surgeries that are known to have a little higher rate of a complication.  For example a reverse total shoulder replacement has a little higher likelihood of having post op problems.  Another example is a Genzyme cartilage transplant procedure which is known to require subsequent clean up arthroscopy.  Therefore it’s important that the patient know if their surgery is a High, Medium, or Low likelihood of having a post op problems.

 

2.  Next the patient needs to know what are the chances that surgery will make them better? Also what are chances surgery will not make any difference or even make things worse. Most Orthopaedic surgery makes people better.  Otherwise we would be out of business.  However this is not 100% guaranteed.  For example a massive rotator cuff tear surgery or a re-do rotator cuff tear is not always successful. Another example is Microfracture, it is not always successful. Therefore it’s important that the patient hear “surgery is very likely to cure your problem” or not!

 

3.  What is likely going to happen if nothing is done? Sometimes nothing new will happen.  Sometimes nothing changes for a long time.  For example it’s impossible to know if a small non-painful rotator cuff tear is going to get worse.  However a large painful tear is going to get worse.  Therefore it’s important that the patient know if it is likely that things are going to get worse or not.  Also if it does get worse does it make the surgery harder?

 

Once a patient has this info the decision can be easier.  Regardless it is a difficult decision and in the end I always tell patients not to decide right now but go home and think about it.

 

I hope you found this information helpful.

 

Steve A. Mora MD

Board Certified Orthopaedic Surgeon in Orange County

You can request a appointment by calling 714 639-3750 or going to web page www.MyOrthoDoc.com and making request.

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