Recognizing ways in which we can improve surgical outcome in an important part of any veterinary practice. Whether the surgery is taking place in your clinic, or being referred to a tertiary center, it is essential to be able to recognize factors that help improve overall outcome so that we can provide the best possible care for our patients and clients. Surgery is not just the act of tissue transformation, but includes the care provided before, during, and after the procedure. The ultimate goal of surgery is successful patient outcome, not just a successful operation.
Measuring Surgical Success
How do we define a successful surgery? In human medicine, there’s a lot of interest in using outcome measurements to improve hospital effectiveness and surgical success. By establishing measurable standards, hospitals are better able to quantify patient outcome. Unfortunately, this is easier said than done. For example, defining positive outcomes for emergent vs routine procedures is very different. A successful outcome for an unstable emergency could be as simple as survival, as compared to the expectations for a routine, elective procedure. In human medicine, several factors have been proposed to help define a successful surgery. The first being time scale; how long does it take for the true outcome of a surgery to become apparent? The second factor is patient follow-up and highlights the importance of rechecks. And the third factor is patient-reported wellbeing and clinical outcome as defined by medical professionals.
At this point in time, there is much less information on the standardization of outcome in veterinary medicine. A recent study has proposed clear definitions and criteria for time frames of data collection, subjective outcomes, and complications in veterinary orthopedic procedures. However, currently there is no outline for soft tissue procedures.
Factors that Influence Surgical Outcome
There are many factors that influence surgical outcome, including patient, surgeon, hospital, client, and more. It is important to recognize the role that each of these factors play in an individual case in order to manage them accordingly and ultimately enhance outcome. For example, comorbidities such as endocrinopathies and anemia can lead to a surgical complication and a poorer prognosis if not addressed pre-operatively. By running pre-op blood work and identifying these potential hurdles, we can take measures to stabilize these conditions prior to surgery in hopes of improving overall patient outcome. Client expectation also has a huge influence on outcome and success. Communication with owners is key in case management. By being as transparent as possible with pre- and post-op expectation, finances, long term prognosis, etc., we are minimizing any potential difficulties that may arise, thus improving outcome.
Surgical Check List
One of the ways in which a hospital can makes changes to help decrease potential surgical related errors is by adopting and implementing a surgical checklist. The concept of a surgical checklist in human hospitals was first proposed by Atul Gawande in his book ‘The Checklist Manifesto.’ Gawande suggests that the checklist’s effectiveness lies in the fact that its application creates a safe space for all hospital personal to speak up if they see something wrong, thus making the hospital a more democratic place. It provides opportunity for technicians and other non-DVMs to provide the surgeon with important information and warnings that could negatively affect outcome. Another major benefit is the low cost nature of a surgical checklist, allowing this technique to be adopted by a wide variety of hospitals.
Since the launch of surgical checklist in human medicine, studies have shown reduced numbers of errors leading to reduced morbidity and mortality. Studies have also shown that the reduction in errors continues over time, demonstrating that the more a hospital uses the checklist, the more effective it becomes.