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Deciding to Have Surgery

The decision to have surgery is a team effort. Both of us need to consider all the options before deciding that surgery is better for you than not having surgery. Ultimately, the decision to have surgery is up to you. Only you know how much your symptoms interfere with your life and what level of risk or uncertainty you can tolerate. Outside the operating room, my primary job is to help you make that decision.

The following information will help you think through these issues:

Be sure that you understand what I am telling you in the office. I try to make things clear and present both sides of the situation without causing confusion. Do not agree to have surgery if you don’t understand what I’ve told you. If you think of questions before or after our visit, write them down so you can discuss them the next time we meet.

Have you tried all the non-surgical treatments and possible options? Sometimes there are no reasonable alternatives to surgery, as in certain fractures and infections. Usually there are non-surgical options that are reasonable. Deciding to have surgery means you have decided the non-surgical options are not the best choice or have failed to work.

Have you considered what will happen if you don’t have surgery? Sometimes there are almost NO serious consequences to not having surgery (like living with arthritis pain for a while longer). Sometimes the consequences are serious – not having a tendon fixed may mean a permanent loss of function in the hand. Be sure you know what is likely to happen if you choose not to have surgery.

Do you understand the expected, possible, and unlikely outcomes of surgery? Unrealistic expectations (mine or yours) can create a disaster and make us both very unhappy.

Know what your diagnosis is and what the surgery is intended to do for you. For example, carpal tunnel surgery will not improve arthritis pain in your thumb. Surgery for arthritis will generally dramatically decrease your pain, but may not eliminate it entirely. Fracture surgery (often plates and screws) is designed to improve the position of bones and joints and increase your chances for good function, but cannot make your hand normal (take you back in time before you had the fracture).

Do you understand the potential complications of your surgery? Almost all surgeries have the following risks:

  • infection (general rates of infection in hand and arm surgery are around 0.5% or less)
  • injuries to nearby structures (cutting a nerve or major vessel is very rare; a more common injury is temporary numbness from retracting nerves during surgery)
  • the need for future surgery
  • failure to completely cure the problem
  • anesthesia complications (these are exceedingly rare – statistically this is the safest part of any surgery on the hand or arm)

Remember, common things happen commonly and rare things rarely occur. Know what the possible complications might be, but don’t make them more serious than they actually are. Know yourself and act accordingly.

I’ve written another article on Surgical Complications in Orthopaedics you may also be interested in.