Before even starting to think about a date for an operation, the surgeon should walk you through the risks and benefits of the procedure he suggests against those of other possible options (including doing nothing at all). Only after you've received and digested his answers should surgery be scheduled. And a crucial part of the discussion should be about the surgeon himself. As David Nash of Jefferson Medical College in Philadelphia puts it: "In God we trust. Everyone else, bring their data."
The critical questions: How many of these operations did you do last year? (For bypass surgery, at least 100.) How many did the hospital do? (Bypass: Look for 450 or more.) What was your mortality rate, and how does it compare with national averages? Lower obviously is better, but slightly higher could reflect a willingness to accept riskier patients and shouldn't be an automatic deal killer. And if you're a 64-year-old diabetic male, say, outcomes in similar patients who had the procedure are relevant, says Thomas Russell, executive director of the American College of Surgeons and a specialist in colon and rectal procedures.
To get a feel for the hospital's commitment to care after surgery, you can inquire about nurse-patient ratios. California, the only state that currently sets specific standards, requires a nurse-patient ratio of 1 to 2 in intensive care and 1 to 4 in the step-down unit, as the patient floor is called. (The latter figure will improve to 1 to 3 next year.) These should be expected targets.
In your talk with the surgeon, you'll be steered through the results of your angiogram, MRI and maybe CT scans, and the surgical plan. Absorbing it all is hard. "On initial discussion, very little is retained," says Glenn Barnhart, chief of cardiac services at Sentara Heart Hospital in Norfolk, Va. Bringing someone who can take notes and think of questions is a good idea. If you must go solo, copious note taking beats memorizing. Pay really close attention to instructions about your current medications. The blood thinner Coumadin, for example, can cause serious bleeding in or after surgery and should be stopped five to seven days ahead of time. If you forget, you'll go for surgery only to be turned away. This is also a good time to ask about management of post operative pain. Depending on the procedure, you may have choices between, say, a regional nerve block and a device that allows you to press a button for a dose of relief, delivered through an iv or an epidural inserted near your spinal canal.
If you can arrange it, making your surgery the first one of the day on a Tuesday, Wednesday, or Thursday has merit. The surgeon might be fresher not coming right off the weekend, and early-morning cases are less likely to get bumped by emergencies. Major surgery on a Friday means you'll be in the hospital over the weekend, when specialists in infection, cardiology, pulmonology, and other backup services are more likely to be on call than on the premises. And late June and July are good months to put off going to a teaching hospital. The "house staff" physicians will turn over with the arrival of a new crop of novice residents. They're bright and well trained, but let them practice before working on you.
Continue reading: Hospital Guide, Part 2: Tests and More Tests >>
This story was originally reported on 7/15/07.