Study: Quicker surgery is better
Friday, January 16, 2015
In a recent study published in the Journal of the American Medical Association (JAMA), researchers found that longer surgery duration is associated with increased risk of blood clots forming in the leg and leading to a pulmonary embolism. What does this mean?
Venous thromboembolism (VTE) is the process by which a person sitting or lying still for a long period of time — think surgery or a long plane flight — develops blood clots in the legs that can travel through the veins to the heart and lungs, leading to difficulty breathing and possible death.
This doesn't happen to everyone just because they have surgery or sit for long periods of time. Of course, we know lots of people who have surgery or take many long flights without this problem. But depending on certain genetic and/or medical factors, blood clots and VTE occur in particularly susceptible people.
In the study above, doctors found one factor that can lead to an increased risk of forming blood clots that travel to the heart and lungs (VTE): prolonged times in the operating room. You might think that if you have a surgical procedure, it's best if the surgeon is slow and methodical to avoid mistakes.
Unfortunately, that is not the case. As the patient lies flat on an OR table without moving, blood pools in the leg veins, forms clots and can travel to the heart and lungs, possibly leading to death.
Surgeons do apply garments/stockings to the feet and legs to reduce the chance of developing clots in the legs, but one additional intervention to reduce the chance of VTE is to shorten the operation. This is easier said than done for some surgeons or some operations.
A liver transplant is a long operation — no way around it. But maybe removing a gall bladder can be done quickly and avoid VTE. Maybe a facelift that takes three hours is better for a patient's health than one that lasts 10 hours.
This study suggests that surgeons should aim to complete operations in as short a time as possible. That's almost impossible to determine ahead of time.
Patients can certainly ask their surgeon how long the operation takes them, but they'd have to ask multiple surgeons during multiple consultations to determine the benchmark. Additionally, patients must weigh how fast surgeons are with how many complications they have.
Surgery that takes an unnecessarily long time to complete is detrimental to the patient, but there's a balance between a short operation and one that is too short and leads to sloppy work. As Albert Einstein once said, "Make things as simple as possible, but not simpler."
Here's another quote I'm fond of: You can have a fast good surgeon, a fast bad surgeon and a slow bad surgeon — notice there's no such thing as a slow good surgeon.
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