Surgical Complications

One of my dogs had extensive dental work recently, including the extraction of two canine teeth. With major extractions, veterinarians frequently use incisions in the gums to gain access to the bone surrounding the roots of the teeth. This usually allows for better exposure and makes it easier to remove the whole tooth. This also frees up gum tissue to use to close over large open sockets after the tooth is removed. While the mouth and gums typically heal well, it is an area of the body that is under constant motion and use which can put a lot of strain on healing incisions. Unfortunately, one of my dog’s incisions came apart a few days after his extractions. Luckily, this complication was easily resolved by sedating him and re-suturing the incision.

 

Complications are a regrettable, yet inevitable part of working in a medical field. Everything we do, everything we learn, everything we train for is to be able to provide the best of care while minimizing complications. While I wish I could give clients my guarantee their pet’s diagnostic work up, anesthesia, or surgical procedures will be complication free; and that with treatment their pet has a 100% chance of an ideal outcome, unfortunately that would not be true. Even the simplest of medical procedures, such as a fine needle aspirate or an injection of medication, procedures that are performed thousands of times daily across the country, carry some risk of complications.

 

While we cannot make these guarantees of zero complications or perfect outcomes, what we can do, and what we strive to do here at Sunstone, is to ensure we are well prepared, trained, and equipped for the procedures we offer our clients. We communicate with our clients so they are aware of the procedure(s) we recommend for their pet, what the procedure involves, any common complications which might occur from undergoing such a procedure, and the likelihood of complications occurring based on the research available and our clinical experience. We want our clients to have a realistic understanding of their pet’s disease process, diagnostic and treatment options, and what risks might be involved in order to make the best decision for their pet and their family.

 

When evaluating risk for my surgical patients, I tend to look at complications based broadly on a few categories.

 

(1)  Anesthetic complications:

While we use safe anesthetic practices and tailor each patient’s anesthetic plan individually, any patient undergoing general anesthesia (or even heavy sedation) is at risk for potential complications. Most complications associated with general anesthesia are mild and easily managed (i.e. decreases in respiratory rate, decreases in body temperature, decreases in blood pressure). However, with any anesthetic event, more serious complications (up to and including death) can occur. The reported peri-anesthetic mortality rate in dogs and cats is pretty low (0.1-2%) but a patient’s individual anesthetic risk is dependent on their overall health status (i.e. do they have concurrent disease, are they systemically ill), why they are undergoing anesthesia (i.e. is this an elective or emergency procedure), and how they as an individual handle and process their anesthetic drugs.

 

Anesthetic complications can occur at any point in time starting with sedation/premedication, at induction of general anesthesia, during maintenance of anesthesia, and within 24 hours after recovery of anesthesia. Late onset effects of anesthesia such as airway irritation, aspiration pneumonia, or esophageal stricture can also occur.

 

To maintain individuals under anesthesia safely, it is important that patients undergoing general anesthesia are closely monitored during and after their anesthetic event and recovery. For that reason, animals undergoing anesthesia at Sunstone are under the direct care of a certified veterinary technician whose primary job is anesthesia monitoring. Almost all patients having surgery at Sunstone will spend the night after their procedures in hospital under the care and supervision of an experienced, certified veterinary technician.

 

If a patient is deemed to be at significant risk for anesthetic complications, we might recommend bringing a board certified anesthesiologist in to work with us in managing the anesthesia aspects of the case.

 

(2)  Surgical complications:

Any time an animal or individual has surgery, there is the potential for complications with the procedure. These can typically be broken down into surgical complications, early post-surgical complications, or late post-surgical complications.

 

With every surgery comes the risk of bleeding, focal tissue trauma, nerve trauma, or complications associated with the specific procedure. The type of procedure and exact body region will influence the likelihood of certain complications. Having surgery performed by someone who is knowledgeable, trained, and experienced in the specific procedure your pet is having can decrease surgical risks.

 

(3)  Post-surgical complications:

Complications that occur within two weeks of surgery are considered early post-surgical complications and are often related to the incision, such as infection, seroma formation (fluid accumulation under the incision), dehiscence (separation of the incision / failure of the incision to heal).  However, early complications may also be more serious or require additional intervention, such as post-operative bleeding or early implant failure / fracture after orthopedic surgery.

 

Most early complications following routine, elective procedures can be avoided with appropriate post-operative care and monitoring; thankfully, most complications are mild and easily managed. However, the nature of complications is that even if we and our clients do everything right with their pet’s procedure and post-op care, complications may still occur. And unfortunately, some complications can be more severe.

 

Late surgical complications are problems that arise multiple weeks, months, or sometimes years, following a surgical procedure. The types of complications which can occur later include delayed healing, implant complications, or late surgical site infection.

 

At the end of the day, my expectation in talking with clients about the potential for surgical complications is not to scare them away from choosing to pursue treatment, but instead to educate and prepare them for what could happen, should complications occur. I always tell my clients if I don’t feel we can anesthetize a pet or perform a procedure safely, then I would not recommend it. Additionally, my desired outcome with any surgical procedure is to ‘first, do no harm’ and ideally to improve some aspect of that animal’s life. Whether the goal of surgery is to provide a diagnosis, resolve a problem, or to relieve pain, I strive to provide a realistic assessment to my clients about whether or not surgery will benefit their animal and what risks may be involved. This way, we can work as a team to come up with the best plan for everyone involved.

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