Download Consumer Guide to Elective Surgery and Procedures

Consumer Guide
Consumer Guide to Elective Surgery and Procedures
Thank you for recognizing your pet may need to undergo an elective procedure such as spay or
neutering. Many people "shop around" for the best price on this surgery, without the knowledge of
why the cost varies among veterinary practices. What is sad is that some places charge a lot, but
still cut so many corners. This guide was put together to help you find the best fit between the
veterinary practice and your expectations for the care of your pet. We recommend you ask for the
details and a hospital tour before booking elective surgery and procedures for your pet..
1.
What pre anesthesia evaluation will my pet have prior to surgery?
This is important for a number of reasons. A physical examination is our first defense
against performing surgery on an animal that may have infectious disease, a heart
murmur, or be debilitated from parasites. A pre anesthesia blood test can detect for
hidden problems that could cause serious complications when the pet is under anesthesia
or in surgery.
2.
What safety precautions will be taken with my pet during surgery?
While most surgery is uneventful, emergencies sometimes arise. Early detection of
impending problems greatly aids our ability to intervene and correct the problem. An IV
catheter will be placed prior to anesthesia induction. The IV catheter is our port for
providing emergency drugs if there is an emergency. Having a catheter pre placed is one
of the most important procedures for safety. IV fluids will be administered to help maintain
blood pressure, provide internal organ support and to help keep your pet from becoming
dehydrated. A breathing tube should be placed (intubation) on all patients requiring
anesthesia longer than a few minutes. This keeps the airway open and allows for
supplemental oxygen or gas anesthesia as needed. This tube is also very important to
prevent aspiration into the lungs if a pet vomits or otherwise has excess fluids/materials in
its mouth. If there is an aspiration, this causes a serious pneumonia. A respiratory
monitor and heart (EKG) monitor allows the surgeon to keep track of heart rate and
rhythm as well as the amount of oxygen in the blood. A Capnography unit is an advanced
monitor not found at many veterinary hospitals. It monitors the wave form of carbon
dioxide during inspiration and expiration and is an extremely sensitive and early indicator
of any pending anesthetic problems.
3.
What safety precautions and comfort measures will be taken?
Anesthesia and surgery patients lose body heat through anesthesia and the opening of
body cavities. Warmth should be provided during and after anesthesia. If patients get cold
the pet becomes uncomfortable and the heart can be affected. Patient temperature
should be monitored at regular intervals after surgery and supplemental heating provided
as needed.
Our hospital utilizes the latest technology to maintain body temperature, which is
particularly crucial in small patients. A warm air blanket called a BAIR Hugger is combined
with IV fluid warmers, warming pads, and heat lamps to ensure optimal body temperature
maintenance An oscillometric blood pressure unit gives continuous blood pressure
readings, with Doppler blood pressure measurements utilized in small patients for which
oscillometric readings are not feasible.
Your pet's gum color, pulse, and respiration should also be monitored.
4.
How will pain be controlled for my pet?
This is very important - surgery hurts! The anesthetic will not provide pain control once
the pet wakes up. Pain should be controlled before, during and after the day of surgery. It
is widely recognized that multi-modality approaches to pain control are the most effective,
and these are utilized in most cases. Aggressive pain control in the early recovery period
has been shown to prevent “wind-up”, and reduce the amount of medication needed
during the later recovery period.
5.
Will I receive written post-surgical care instructions for my pet?
Aftercare of surgical patients is very important for proper healing. The hospital should
provide written discharge instructions for your pet.
6. In what ways can the services be compromised to lower competitors
prices?
There are so many ways that corners can be cut. Although your pet may survive the
procedure, greater risks maybe taken. These risks are known to increase the chance of
infection, pain, suffering and death. Since there are no laws that regulate these issues
in Washington State, some veterinary hospitals cut corners to be able to offer the lowest
price possible. We firmly believe that the clinics that cut corners are not adequately
informing their clients of the risks involved. We believe owners should have choices and
should not be disrespected if they cannot afford uncompromising care, but feel all pet
owners should be informed that the lowest price probably means the lowest service. We
have researched all the issues to develop our protocols. We believe our patients deserve
uncompromising care.
The facility
The patient should be prepared for surgery in a preparation area, not in the surgery
room. This prevents hair and debris from possibly contaminating the surgery area.
It is expensive to have an area where only sterile surgeries are performed. So, if the
surgery area is not a single use area infection rates are increased by increased traffic
within the room. Performing surgeries or procedures that are not sterile' surgeries in the
surgical suite increases infection rates. Having a sink in the same room as the surgery is
completed increases infection rates. Carpeting or poorly maintained flooring, ceilings and
or walls in the surgery room increases the infection rate as these can harbor debris,
bacteria and viruses.
Preparation of the patient
The patient should be examined and many should have a pre anesthesia screen. In most
young healthy pets, this is a simple blood test. In pets that are a little older or have other
issues discovered a urinalysis might be recommended. Chest radiographs or other
evaluations may be recommended or required. To reduce the cost of procedures, these
screening tests may be completely omitted. Abnormalities may then not be detected until
it is too late, or may make recovery after the surgery much harder on the pet and the
owner.
Once the pet is in the hospital on the morning of the procedure, medications should be
used to relax the patient and start the pain management program. Again, forgoing this
step leads to a much more nervous pet, which increases the release of epinephrine in the
system and can actually lead to increased abnormal heart contractions. Of course, it is
cheaper to delete this step.
As noted above, not placing an IV catheter, not starting IV fluids, no intubation, not
monitoring for respiration and heart rate and rhythm all reduces the cost of the procedure
at your pets risk.
The patient should be clipped, vacuumed free of debris and special disinfectants used to
prepare the surgical area prior to being moved into the surgical suite.
Surgical preparation and attire of surgeon and assistants
Surgeons and assistants should prepare themselves to prevent contamination by wearing
a surgical cap and mask. They should scrub their hands three times before donning a
sterile surgical gown and gloves. It is somewhat ironic that food workers are required to
wear a cap or somehow control their hair, but veterinary surgeons are not.
Surgical instruments and supplies
Instruments used should be of high quality and well cared for. Using less than high quality
instruments can lead to increased tissue trauma and increased pain and a longer healing
time. The surgical pack of instruments should be used on only one pet, then cleaned,
lubricated, repackaged and sterilized. Using instruments on more than one animal
between cleanings and autoclaving can lead to increased chance of infection and
infectious disease.
Surgical gloves should be disposed of after each surgery. In some hospitals, gloves are
reused. The chance of microscopic holes in them drastically increases, leading to
increased rates of infections and complications. Of course that is still better than in the
places that are not using gloves at all, or are using non sterile exam' gloves for surgery.
The choice of suture material varies greatly. The differences may not be readily apparent
to pet owners that cannot compare differences, but those who have studied and tested the
choices have published that there are differences on both gross and microscopic
levels. Some places reuse suture materials not used up from a prior surgery. These
materials have been dragged through the tissues of the prior animal and may be placed in
a cold sterile' solution until used again. Obviously, infection rates can be increased as
well as tissue trauma. Suture materials may even weaken from such practices. Another
cost cutting method is to use suture off a reel. This is an inexpensive way to purchase
suture materials. These sutures are then rolled off the reel and threaded through a needle
(which may have been used on multiple pets in the past and be dull). The longer the reel
has been in use, the greater the chance of contamination, all this leading to higher
infection rates. Additionally, the suture that is threaded through the needle leaves a much
larger hole in the tissue it penetrates. This increases tissue trauma, pain and healing
time.
The alternative is to use suture materials that are prepackaged for single use and have a
swaged on needle. The suture material is one piece with the needle and is inserted into
the rear end of the needle. This allows for very tiny, non-traumatic punctures that produce
less pain and tissue trauma. Since the needles are then used only for that, the needles
stay sharp, again leading to decreased pain and tissue trauma.
Suture selection also involves determining what material to use. Some materials are not
very strong, and cause increased inflammation within the tissues or the knots can even
untie. These materials are very inexpensive. Better products have less reaction, with less
pain and tissue trauma/inflammation caused, allowing faster healing and greater security.
The surgery performed
Most surgeries for spays and neuters are performed swiftly and with skill at most
hospitals. We have mentioned many things that can change how the patient is after the
surgery even if the typical owner cannot appreciate the difference. The above-mentioned
cost cutting choices have in the past and may still occur at some places. In addition to not
cutting corners we usually close the surgical site with hidden' or buried suture
patterns. This means, that the pet does not have to return for suture removal saving you
time. We also do not need to give any prophylactic antibiotics to cover for sloppy
service. We have an open invitation for our pet owners to bring their pets by at no charge
post surgery to check the surgery site, or for any post op complications due to our service.
Thanks to Lisa Bennett DVM from Beaver Lake Animal Hospital for sharing this
document (with modifications).