Factors that Affect Surgical Decisions

Surgery is not a straightforward remedy for all. Surgical procedures come with risks. The patient's overall health status usually affects many of the decisions the surgeon makes before and during the surgical procedure. Following are the key considerations:

1. PATIENT'S AGE:
With aging, both skin and muscle tissue lose their tone and elasticity. Metabolism also slows, and circulation may be impaired. All of these factors delay healing. Surgeons usually discourage patients to undergo elective procedures at an older age not only because of these factors. People are more likely to have other compromising medical conditions at an older age.

2. PATIENT'S WEIGHT:
In obese patients of any age, excess fat at the wound site may prevent securing a good closure. In addition, fat does not have a rich blood supply, making it the most vulnerable of all tissues to trauma and infection. The surgeon can place the patient on diet to lose weight with the help of a nutritionist. However, exceptions are made for the surgeries which are aimed at enhancing weight loss. That decision is made by the surgeon and the patient to handle morbid obesity. The benefits then far outweigh the risks.

3. PATIENT'S NUTRITIONAL STATUS:
Deficiencies in carbohydrates, proteins, zinc, and Vitamins A, B, and C can impair the healing process. Adequate nutrition is essential to support cellular activity and collagen synthesis for healing. On many occasions the surgeon will place the patient on improved diet with the help of a nutritionist.

4. DEHYDRATION:
If the patient's system has been depleted of fluids, the resulting electrolyte imbalance can affect cardiac function, cellular metabolism, oxygenation of the blood, and hormonal function. These effects will not only impact upon the patient's overall health status and recovery from surgery but may also impair the healing process. Therefore, the surgeons as a routine run the blood tests on the patients to determine such imbalances. Once detected, it can easily be corrected to clear the patient for the surgery.

5. INADEQUATE BLOOD SUPPLY TO THE WOUND SITE:
Healing takes place most quickly in the face and neck which receive the greatest blood supply, and most slowly in the extremities. The presence of any medical condition that compromises the blood supply, such as poor circulation to the limbs in a Diabetic patient, will slow the healing process.

6. PATIENT'S IMMUNE RESPONSES:
Immune response protects a patient from infection. Therefore, immunodeficiency may seriously compromise the outcome of a surgical procedure. Patients infected with HIV, as well as those who have recently undergone chemotherapy or who have taken prolonged high doses of steroids or any other immunosuppressive medications, may have debilitated immune response.

Some patients have allergies to specific suturing materials or metal alloys. These, on the other hand, will cause a heightened immune response in the form of allergic reactions. This may interfere with he healing process itself. Therefore, the surgeon should always check beforehand on a patient's allergies.

7. THE PRESENCE OF CHRONIC DISEASES:
A patient whose system has already been compromised by chronic illness, especially endocrine disorders like Diabetes Mellitus, will heal less quickly and will be more vulnerable to post-surgical complications.

8. THE PRESENCE OF MALIGNANCIES, DEBILITATING INJURIES, OR LOCALIZED INFECTION:
All of these conditions merit concern, and the surgeon must consider their effect upon the tissues at the wound site, as well as their potential impact upon the patient's recovery from the procedure overall. Malignancies, in particular, may alter the cellular structure of tissue and influence the surgeon's choice of methods and closure materials.

9. INTERFERENCE BY OTHER MODES OF TREATMENT OR MEDICATION:
The use of corticosteroid, immunosuppressive or anti-neoplastic drugs, hormones, and radiation therapy may impair wound healing.