Day Surgery: The Myth Of The Prepared Patient

Jonas was scheduled for a high-tech surgical procedure to take a close look at an aneurysm in his brain. If such a procedure had been available 25 years ago, it probably would have involved sawing off part of his skull, taking a look, and putting the skull back in place. The operation would have taken hours. There would have been a huge risk of infection. It would have hurt. It would have taken months to fully recover. On top of all that, most of us have distinct aversion to anyone sticking a scalpel in our brains.

Jonas, however, was scheduled for modern brain angiography. The surgeon cuts a tiny, 3 mm (1/8 inch) incision in the groin to reach the femoral artery. He or she inserts a tiny, thin tube called a catheter into the artery that then is manipulated to travel into the brain. The tube delivers a dye that makes brain tissues easier to see on X-ray. There is no need for general anesthesia, although most patients are given a drug like Versed (midazolam) so they won't wiggle around. (Wiggling on the operating table really isn't something you want to do during brain surgery.) There aren't any stitches. There is no pain. You can do ordinary activities with a week, and there are no scars and no need to shave your head.

He had been told to take Prednisone to stop any potential allergy on the table, but he had forgotten it. Jonas had been told not to eat or drink after midnight for his 9 o'clock procedure, but he had stopped off for a breakfast sandwich and coffee on the way to the hospital. In addition to all that, the doctor had ordered an EKG to be taken before the procedure, and Jonas had been too busy the week before to have it.

The story of Jonas is not all that unusual. A Medscape survey asked doctors and nurses how well prepared patients are when they come for day surgery:

• 5 percent reported that their patients come to surgery as well prepared as they would expect.
• 15 percent reported that their patients were not well prepared and reported being "too busy" to attend preparation classes or to do their assigned tasks at home.
• 34 percent reported that their patients were not as well prepared as they "used to be."
• 45 percent answered "it depends," that some patients were prepared and some were not, largely depending on their ages.