Surgery
Surgery is the field of medicine that focuses on operative treatments of the body. Although the technical skills to perform operative surgery are a fundamental part of surgery, these skills are secondary to a body of knowledge that comprises the core of surgical thinking. That knowledge includes human anatomy, a working understanding of hemostasis, wound healing, nutrition and all the aspects of normal physiology in the healthy patient, and pathophysiology in the diseased patient, that directly bear on achieving successful surgical treatment. Training in surgery includes operative training, and the diagnosis and treatment of disease in the surgical patient before and after surgery. The actual practice of a surgeon depends on specialty and subspecialty training, and the health care system in which the practice occurs.
Evidence-based surgery
"The turning point in the evolution of evidence-based surgery can be attributed to Ernest Amory Codman who, in 1910, began efforts to reform clinical medicine and surgery... Codman created a case monitoring system in 1900 to record outcomes."[1] His was the first system in which the outcome of a large number of individual patients were compared according to the operation performed, and the surgeon performing the operation.
Risks of surgery
The risks any surgical procedure include potential harm from the actual operative procedure, anesthesia and other medications administered, and postoperative complications from wound healing or restricted activity.
- Idiosyncratic reactions to anesthetic medications
- Thromboembolic disease such as pulmonary embolus or deep venous thrombosis
- Postoperative wound infections
- Excessive intraoperative or postoperative bleeding
- Cardiovascular disease, such as heart attack or stroke
- Endotracheal tube complications, such as laryngeal damage, or trauma to the hypopharynx
- Soft tissue graft failure
- Bone Osteonecrosis
Patients undergo a counseling session to understand the risks and benefits of the procedure, and the treating surgeon must obtain informed consent before proceeding.
Anemia
Prophylactic iron or erythropoietin does not seem helpful.[2][3][4][5]
References
- ↑ Toby A. Gordon: Chapter 14 - Evidence-Based Surgery, in Greenfield's Surgery: Scientific Principles and Practice. 2006 Lippincott Williams & Wilkins Philadelphia
- ↑ Karkouti K, McCluskey SA, Ghannam M, Salpeter MJ, Quirt I, Yau TM (January 2006). "Intravenous iron and recombinant erythropoietin for the treatment of postoperative anemia". Can J Anaesth 53 (1): 11–9. PMID 16371604. [e]
- ↑ Weatherall M, Maling TJ (December 2004). "Oral iron therapy for anaemia after orthopaedic surgery: randomized clinical trial". ANZ J Surg 74 (12): 1049–51. DOI:10.1111/j.1445-1433.2004.03265.x. PMID 15574145. Research Blogging.
- ↑ Madi-Jebara SN, Sleilaty GS, Achouh PE, et al (February 2004). "Postoperative intravenous iron used alone or in combination with low-dose erythropoietin is not effective for correction of anemia after cardiac surgery". J. Cardiothorac. Vasc. Anesth. 18 (1): 59–63. PMID 14973801. [e]
- ↑ Weisbach V, Skoda P, Rippel R, et al (May 1999). "Oral or intravenous iron as an adjuvant to autologous blood donation in elective surgery: a randomized, controlled study". Transfusion 39 (5): 465–72. PMID 10335995. [e]