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Pre Op Check list - patient    Risks and complications
Understanding the risks involved with surgical intervention is the most difficult concept for patients to fully understand. Decision making sometimes becomes easy after one has tried all other means to relieve pain and suffering and have failed.

No daily activity is ‘risk free’. Whereas some activity carries very low risk (say sitting in your sofa), some carries higher risks but we willingly take it (like driving a car or travelling by plane). When risks are quoted in percentage terms, I find it difficult to ‘visualise’ this. For example death in road traffic accident in Britain is roughly 1 in 10,000. What does that mean?

I find it easy to convey the risk percentage when I refer to the chances of one winning £10 in the National Lottery Lotto draw. Statistically the chance is 1:57.  What it means is that, on balance, one may have to spend £57 to get £10 back. However, it does not mean than if you were unsuccessful 56 times, you are guaranteed to win the 57th time. The chances of you winning £1 million is less than that chance of being stuck by a lightning. But we have heard about people who match 6 numbers on the news many times..

Before one talks about the risk of operation, the first question one needs to answer is “what is the risk of not having the operation?”. Is this operation needed or is it a treatment of convenience?

Risks from surgery can be categorised as general risks and those that are specific to the procedure. Some can be classed as ‘side effects’ from the intervention. General risks include those from anaesthesia and nerve block (like sore throat, damage to lips/teeth, reaction to drugs, reaction to plaster,
temporary or permanent damage to nerves, pneumothorax etc). General risks also includes risks like Deep Vein Thrombosis (DVT) or pulmonary embolus (PE). The risk of DVT/PE are very low in shoulder surgery and usually in the region of 1 in 500 or less. The risk of death is lower than this. Other rare risk includes reaction to skin preparation agent (like chlorhexidine gluconate). The ‘risk’ of a poor outcome is greater in degenerative disease as your body continues to deteriorate with time. Thus surgery can only contain the problem and not reverse the degeneration.

Specific risks include infection (less than 1%), damage to nerves or blood vessels (less than 0.5%), stiffness(variable depending on procedure up to 10%), bleeding (less than 1%), slow recovery(5% or so), recurrence(less than 1% depending on diagnosis), need for further surgery, failure to resolve symptoms fully (about 1%), sensitive scar, scar hypertrophy, numbness around scar, and rare complications like complex regional pain syndrome (under recognised about 0.5%) etc. The list is not exhaustive. These risks vary in frequency depending upon the diagnosis and the actual type of procedure done. Aggravation pain can be considered as a side effect of the surgical intervention.

Patients with other additional diseases are more likely to suffer complications. Patients with diabetes have higher risk of infection or developing stiffness. Men in a certain age group who have experienced symptoms of prostatism may develop retention of urine after the anaesthetic needing catherisation. Sometimes pre-existing conditions which have not yet been diagnosed will become manifested after operation.