Hospital surgery is an event that most people face several times during their life. I hope this blog about my own experience helps you enjoy surgery success when it comes your way.
I have divided this blog post on hospital surgery into five installments. They treat different aspects of hospital surgery in general and my surgery in particular.
The first three parts apply to virtually every reader of this blog:
– 1: What Everyone Must Know (This Post) – hospital documentation and infection prevention
– 2: That Scary Anesthesia – minimizing the risks from anesthesia
– 3: Recovery & Departure – what you can expect after waking from surgery
The final two parts apply to men only, especially men over fifty. They talk about my specific surgery:
– 4: Prostate Enlargement Versus Cancer – problems of the prostate and their cure
– 5: Prostatectomy Cures BPH – prostatectomy as the definitive cure for an enlarged prostate, also known as BPH
We’ll now proceed to discuss hospital surgery in general, and the serious problem of hospital infections in particular.
Hospital Surgery is Quite Common
Hospital surgery is far from rare in the U.S. Surprisingly, I only found one study that tells us just how common it is.
You may know surgeon Dr Atul Gawande from his best-selling books about the human side of medicine. He is also the co-author of a 2008 study counting the expected surgical procedures during an 85-year lifespan. An average U.S. citizen can expect six hospital operations: 3.4 in-patient and 2.6 out-patient. In addition, he or she can expect 3.2 invasive “procedures” that do not require a hospital operating room.
The most common operations for men are coronary angioplasty, wound debridement and groin hernia repair. For women they are cesarean section, gall bladder removal, and lens and cataract surgery. This is a very wide range of procedures. However, the discussion in parts 1, 2 and 3 of this blog will apply to almost all in-patient hospital surgery.
Scope of this Blog
I have previously written about two related topics
– The increasingly serious problem of hospital-acquired infections.
– Obstructive sleep apnea, a condition that can kill you if the anesthesiologist does not properly protect you during hospital surgery.
This blog is different from most on ArtChester.net. Instead of talking science, I’ll relate my personal experience with hospital surgery in mid-May. You may find this to be helpful preparation for the hospital surgery that almost every one of us will eventually undergo. You may be interested to see the extreme steps that (what I believe to be) a typical modern hospital takes, to protect their patients. Or you may enjoy my story simply because you can sit back and say, “Thank goodness that I didn’t have to go through that!”
Choice of Hospital
In my local area there are several large, well-respected hospitals. I chose Grosse Pointe’s Beaumont Hospital in part because my surgeon often operates there. In addition, my family doctor is on staff at Beaumont and they have an excellent reputation for successful outcomes, lack of complications and overall quality.
On balance, I am very happy with this hospital, despite minor complaints to be mentioned in a later installment. I have no reason to believe that other hospitals in my area might be inferior, because I simply don’t know. And I am not in a hurry to find out!
Paperwork Related to Hospital Surgery
It’s no surprise that hospital surgery entails a great deal of documentation. The patient sees this in printed form, and digital copies also reside in the hospital’s data system. I’ll summarize these here. The most important part of today’s blog will be to discuss infection prevention in some detail.
– Confirmation of insurance and contact details (via a phone call with the Admissions Department).
– Medicare notice of patient rights.
Beaumont Hospital Information Brochures:
– Welcome letter from President and Chief Medical Officer.
– Your Guide to Surgery (how to prepare, what to expect).
– Patient and Family Guide (comprehensive information plus contact numbers).
– Rapid Response Team (how to get help in case of problems).
– Understanding Pain Management (types of pain control, and patient options).
– My Beaumont Chart (Beaumont’s online medical records for patient access).
– Room Service Menus (Heart Healthy / Regular; and Soft / Mechanical Soft).
– Feedback forms to recognize excellent staff performance.
– Preventing Blood Clots While Hospitalized (information plus advice for patients).
– Brochures on “quitting smoking” and “meals for the homebound” (neither relevant to me).
– Medication reminder card for patient use.
Documents Specific to my Surgery:
– Scheduling form specifying date, location and type of surgery.
– Filled out and submitted by me: complete medical history, list of prescriptions and supplements, contact information.
– Surgical Preadmission Testing Orders: instructions for me to get a number of blood tests, plus an EKG and surgical clearance from my cardiologist.
– Pre-Procedure Instructions.
– Prohibition against aspirin and other blood thinners for 7 days prior to surgery.
– Prep for Prostatectomy (bowel cleansing instructions).
– Detailed instructions for preventing infections: home showering prior to surgery, steps taken by hospital, wound care after surgery.
– Discharge Instructions and Physician Orders (detailed post-surgery instructions).
– Surgical Pathology Tissue (description of removed tissue to be biopsied).
Printouts Provided by Hospital Nurse:
– Benign Prostatic Hypertrophy (this appears to be a typo for “hyperplasia”).
– Foley Catheter Placement and Care (description, problems to watch for).
– Urinary Leg Bag (detailed care and antiseptic instructions).
– Laxative, Stool Softeners.
Prevention of Infection in Hospital Surgery
Regular readers may recall my 2014 blog about hospital infections. Since then, the problem of surgical site infections has gotten worse, not better. The World Health Organization underlined its seriousness in November 2016 by issuing its first-ever Global Guidelines1 on the Prevention of Surgical Site Infection.
Rise in Antibiotic Resistance
One of the problems making infections more serious is the spread of antibiotic-resistant bacteria.
Journalist Michael Jorrin has detailed the alarming world-wide increase in antibiotic resistance. He points an accusing finger at pig farmers in China, who fatten their porkers with tons of colistin, one of the antibiotics of last resort. However, he also deplores all livestock production relying on antibiotics to fatten animals for market.
Traces of these antibiotics linger in every ounce of non-organic chicken, beef and pork that we eat. More critically for world health, animal antibiotics join over-prescribed human antibiotics in stimulating the spread of antibiotic-resistant strains of bacteria.
Since our arsenal of infection-fighting medicines is shrinking drastically, it becomes all the more important to prevent infection. This is especially true in a hospital, where medical procedures may breach or weaken the normal defenses of the body. In addition, it’s known that bacteria can be spread from patient to patient2 by bedrails and other surfaces in the hospital room.
Beaumont Hospital’s Anti-Infection Program
As mentioned above, one of the Beaumont Hospital handouts dealt with preventing infections. It estimated an incidence of surgical site infections of 1% to 3%. This sounds better to me than the 2% to 5%3 I have seen quoted, and CDC’s estimate of 4%. Therefore, hopefully Beaumont’s anti-infection program is showing success.
One side of the handout had a detailed discussion of surgical site infections, steps being taken by the hospital and steps to be taken by the patient. The other side gave detailed instructions for cleansing, disinfecting and hygiene the night before and the morning of surgery.
Here are a few features that were new to me, but which seemed to make sense:
– It is customary to remove hair surrounding a surgical incision. However, the hospital has banned all use of razors or shavers. The staff uses only a clipper that’s designed not to scratch the skin, since even a small abrasion can give entry to bacteria.
– Antibiotics are given to the patient intravenously prior to and during surgery, as well as within the following 24 hours.
– The night before surgery patients are instructed to shower, then wipe the entire body with chlorhexidine gluconate (CHG) antibacterial solution, excepting only the head and the genital area. They must dry with a freshly laundered towel. They then don clean night clothes and sleep between clean sheets with clean pillowcases.
– The patient repeats the entire showering and cleaning procedure the morning of surgery, again drying with a fresh towel.
Additional Anti-Infection Steps
I learned from my surgeon that in addition to extensive cleansing and disinfecting protocols, he bathes the surgical area with an antibiotic solution prior to closing the incision.
As an illustration of the extreme seriousness with which our local medical community takes infection prevention: I acquired a finger infection (paronychia) for which I consulted my dermatologist. She pointed out that infecting bacteria had probably entered my finger through a torn spot in my cuticle. She went on to say that she regularly lectures her (female) patients to not push back their cuticles. The cuticles are one of nature’s barriers to keep foreign bacteria out of the body, and should not be disturbed. (I imagined a customer trying to explain that to her manicurist! But I refrained from comment.)
This concludes Part 1 of this five-part blog on hospital surgery. Part 2 discusses the anesthesia process in detail, especially the steps hospitals take to minimize the risk it poses to surgery success.
Image Credit: Photos taken by Art Chester
I learned stuff even though I have been hospitalized several times.
Can’t wait to read the anesthesia blog, but it will wait until tomorrow.
Thanks mucho, Art. Jackie
Thanks, Jackie! Watch this space!
[posted Jun 4, 2017 on behalf of subscriber Nick Greaves]
This is very interesting for me Art, not only because I have a slight suspicion that I might have to go through the same procedure in due course, but also because number two son Felix, the medical Doctor specialising in public health, has written papers comparing the NHS in the UK with the American system, so I will draw his attention to your reports.
Subjectively I submitted to the tender care of the NHS in Oxford last November and they gave me a new knee, well half one, and it has done me very well considering that last October I could only limp slowly 300 yards to the local Co-op supermarket in the village. This was because my knee finally gave up after overdoing some ill advised dancing on the Chelsea Arts Club, (it is my wife who is the member and she likes to dance) a few months previously, to an excellent 1970s early punk band, Jah Wobble, so inspirationally tight that I managed slip effortlessly to the floor during a complicated manoeuvre which did for my already nearly useless knee.
Anyway, I requested a quote to have it done privately: £11,500 and since I do not bother with insurance, I chose the NHS. With increasing age I have belatedly realised that when we moved close to Oxford in 1978, that it was worth being close to a good teaching hospital if one relied upon the NHS. The professor surgeon supervising had a degree in engineering at Cambridge before he turned to medicine, although the flaw with the NHS is that you never know who will be doing your operation and I knew that the professor would not be heavily involved unless it went wrong. However when an hour before I was wheeled into theatre, I met the professor, the anaesthetist and the knee fellow who would actually be wielding the circular saw. The latter was about 40, already grey haired and looked competent.
My doctor son who now advises the Government how to spend their money on health, has a slight disregard for surgeons and did not hesitate to tell me there was one elderly surgeon in the Oxford hospitals who allegedly was constantly sent on lecture tours to keep him out of actually operating. But for me, the surgery was a life changer other than now my operated leg is so energetic that it has put my unoperated leg under unaccustomed strain and I realise that I will have to have that one done as well before much time passes.
One other observation from my doctor son when in the midst of a couple of years post graduate Public health at Cambridge (Massachussetts), is that when he had diagnosed himself with acute appendicitis, before the operation, the hospital carried out a comprehensive and no doubt very expensive scan and analysis of every possible ailment he might have. Fortunately he was well insured by the providers of the scholarship. That is obviously a major difference between the two different health systems.
Art, I wait agog for the next instalments.
Best wishes as always
Nick, many thanks for your comments, especially when they are as fascinatingly autobiographical as this one!
If Felix wants to compare NHS with my experience, he needs to know that my medical insurance is Medicare, which is the most comprehensive and patient-friendly insurance widely available in the US – although only available to those over 65! Insurance for younger folks is catch-as-catch-can, unfairly distributed, often unaffordable and often highly restricted. Nevertheless, the experience in my blog is not dependent on Medicare. It captures what happens when a patient gets popped into a good-quality hospital with his choice of surgeon and with his or her care paid for from whichever source.
It’s great that Felix was so well cared for in Massachusetts. However, I don’t think that his care reflects any kind of US-wide standard, either for insurance coverage or care.
I congratulate you on your successful knee replacement. I have friends who had knee surgery and they seemed very happy with the results. I wish you equally great success when and if you proceed with the other knee, thereby becoming biodynamically symmetrical once again. I look forward to your positive reports from future dances at the Arts Club!
I hope you are recovering well, Art. I’m looking forward to the next installment. Kevin developed post-operative cellulitis after vascular surgery in January, despite the fact that the hospital went to great lengths to prevent infection. Microbes are our masters! Thank you for your blog.
Thanks for your comment, Martha. I hope that Kevin feels well healed now. It’s true that despite the hospital’s best efforts, and our own, infection is always a risk. It’s becoming a major battleground for medicine. More to follow next week! – Art
As always, your blog is clear and informative.
Look forward to your next blog on anesthesia.
Hope you are well.
Thanks, Zenon! You’ll be able to track my recovery through this blog (at least for the next few weeks). It was a topic that, once I got into it, got so big that I had to divide it up. Good health to you too! – Art