7 Reasons to Call Off a Surgery
A Trainwreck
In the movie "Trainwreck," Bill Hader's character, a surgeon, goes to work after too little sleep and marks the wrong knee of the patient he's prepping for surgery. Worried about the doctor's ability to perform, the patient flees -- hospital gown on, IV lines in and anesthesia already beginning to work its magic. While the scene is intentionally over-the-top, it raises the question: When should you call off a surgery?
First, when not to...
Of course, emergency surgeries after, say, a serious car accident or to treat a brain aneurysm are no time to be asking, "Do we have to do this now?" But non-emergency procedures, such as knee replacement surgery, hernia repair or preventive breast cancer surgery, should be well-thought out before the patient moves forward, says Joe Kiani, founder of the Patient Safety Movement Foundation. "The beauty of those [surgeries] is ... that you're not in a rush, so you can schedule it with your homework done."
Sleepy Surgeons
Despite the message in "Trainwreck," recent research suggests that sleepy surgeons can still be effective. The study compared the patient outcomes of 1,448 surgeons who had been working after midnight the night before with outcomes after a night's rest -- and found no difference. That doesn't discount the importance of sleep, but suggests the surgeons in the study monitored their ability to perform successfully, says lead researcher Dr. Nancy Baxter, chief of the division of general surgery at St. Michael's Hospital in Toronto. "Physicians do self-regulate," she says.
Got the jitters?
Another not-so-great reason to postpone a surgery is nerves -- so long as they don't reflect deeper concerns about the procedure or surgery team. "Anxiety is completely normal around the time of surgery because there are so many things you can't guarantee and predict," says Baxter, also a surgery professor at the University of Toronto. Don't hesitate to tell your surgeon you're on edge -- you won't be the first, Baxter says. "We [do] have things that can help people through this." There are legitimate reasons, however, to halt a surgery...
1. Your health suddenly changes.
For one, if you come down with a serious medical condition like a severe fever or sudden respiratory infection (not just a cold), it may be best to reschedule the procedure, says Dr. David B. Hoyt, executive director of the American College of Surgeons. But deciding whether or not to do so isn't a burden patients should carry, Baxter says. "The main thing to do is talk with the surgeon and anesthesiologist about any changes in your condition or any new problems that have arisen," she says. The pros won't put you under unless it's safe.
2. You haven't sought a second opinion.
Before any elective surgery, make sure to consult with a variety of professionals, including surgeons in academic medical centers and private practice, Kiani suggests. The first doctor's feelings shouldn't be hurt if you don't commit to him or her right away. "Honesty is the best policy," he says. "Any surgeon that's worth you getting a procedure done with will understand the logic of, 'Thanks for the advice, but I'd like to learn more.'"
3. You have qualms about your surgeon.
Feel intimidated, rushed or uncomfortable around your surgeon? Time to look elsewhere. Hoyt advises turning to your primary care physician for a recommendation, asking the surgeon about his or her experience with the procedure and trusting your own face-to-face judgment. Baxter suggests asking surgeons if they have ever cancelled surgery because they weren't mentally or physically up for it. A "yes" suggests they're self-aware. "If anything can affect [surgeons'] ability to perform at the highest level, [they] should either be cancelling or getting help," she says.
4. You haven't chosen an anesthesiologist.
Just as patients have the right to choose a suitable surgeon, they have a say in who puts them under. "You can pick your anesthesiologist and be just as confident in them as the surgeon," Kiani says. "It's really a team effort." To find one, ask your surgeon for a recommendation given your condition, age and other considerations such as allergies or medical history. Then, schedule the surgery when the surgeon and anesthesiologist are both available, Kiani says.
5. There's no team spirit.
The quality of your medical team has to do with more than just who's on it. "If [surgeons] are working in an environment where there's a lot of bravado, where they don't work in teams and they don't ask for help," they're more likely to go forward with a surgery when they'd be better off resting and rescheduling, Baxter says. Fortunately, that attitude is increasingly passé. "The change since I've been a surgeon has been really monumental -- and it's benefiting patients," she says.
6. The facility is questionable.
Where you have your surgery matters, too, Kiani says. "You want to pick a hospital that's really trying to achieve greatness," he says. That means a commitment to safety -- not a great parking structure, he adds. To find a reputable choice, check the U.S. News Best Hospital rankings or the Patient Safety Movement Foundation's list of hospitals that have made a commitment to zero preventable deaths by 2020.
7. You have unanswered questions.
If you roll into an elective surgery uninformed or unprepared, roll out. But don't let it get to that point. "Be a proactive member of what's happening" throughout the whole process, Kiani says. "Great hospitals, great doctors and great nurses will not be offended with [patients'] questions and their assertiveness." And remember: "This is not getting your hair done. This is not getting your car washed," Kiani says. "This is letting a knife go through your body and being put out with very powerful drugs."
