Unfortunately, the risk for medical errors during surgery is real, including wrong site surgery, items left in the patient, introduction of infections, and the wrong procedure being performed. How can you improve your surgical outcome? Read on for some important tips.
What is a surgical outcome?
Simply put, surgical outcomes measure how well patients fare after a surgical procedure, including their symptoms, functional status, quality of life, satisfaction with the results, and costs.
How can you improve your surgical outcome?
Fortunately, there are many steps you can take before and after your surgery to give yourself the best chance of a successful outcome.
1. Look for a hospital with a quality nursing program.
Researchers found that patients do better when nurses have better working environments. The study found that “hospitals with well-staffed, top-notch nursing departments had fewer deaths after surgery than hospitals without those high-quality nursing environments.”
According to the article, good nursing environments have more than 1 nurse for every hospital bed, as well as having “Magnet Status”, a special accreditation from the American Nurses Credentialing Center. The study found that being in a hospital with a good nursing environment reduced the odds by nearly 50% of a patient needing ICU care. Find a hospital in your area with Magnet Status here.
2. Find the “right” surgeon.
Additionally, ask any potential surgeon the following questions:
- Is he/she Board Certified in Surgery?
- Does he/she have a F.A.C.S. (Fellows of the American College of Surgeons) designation ?
- How many operations similar to yours has the doctor performed in his/her career? How many/year? Unless you have a rare condition, try to find a doctor who has performed your particular procedure hundreds of times, if possible.
3. Find the “right” hospital.
In addition to looking for the “right” surgeon, it is equally important to investigate any hospital you might use. First, there are several sites you can use to look up hospitals:
- Find out if a hospital is accredited by the Joint Commission, a sign of a “gold standard”.
- Look up a hospital using Leapfrog’s Hospital Safety Grade reports. They assign letter grades based on a hospital’s ability to protect patients from preventable errors, accidents, injuries, and infections.
- Use Medicare’s Care Compare website to see their star ratings for hospitals nationwide based on their performance across five quality categories.
- Use U.S. News and World Report’s “Best Hospitals” report includes information on hospitals for 25 adult specialties/conditions and 10 pediatric specialties.
Additionally, ask the surgeon the following questions about the hospital he/she plans to use for your surgery:
- Does the hospital enforce the use of surgical checklists?
- How often do surgeons perform your particular procedure at this hospital?
- What hand hygiene and other infection control programs are in place?
- If you will be hospitalized after the surgery, will you be placed on a floor that specializes in your condition? How can they make sure that will take place?
Lastly, look for a hospital using a post-surgical recovery processes called Enhanced Recovery After Surgery (ERAS). With these programs, patients experience faster recovery, shortened hospital stay and significantly fewer complications. Unfortunately, there are currently not many hospitals following this protocol, but it’s worth asking your surgeon if the hospital uses the ERAS protocol.
For more tips, read How to Choose a Hospital.
4. Choose the best time for your surgery.
Consider these suggestions to improve your chances of a positive outcome:
- If possible, schedule your procedure for Monday or Tuesday. Avoid Thursdays, Fridays, and weekends. Importantly, researchers found that patients who had surgery on a Friday had a 33% higher chance of dying than those who had the same surgery on Monday. The authors hypothesize when recovering over a weekend, patients face less experienced workers, longer wait periods, and reduced access to test results and diagnostics. Similarly, a study of 430,000 surgical patients found that patients who had surgery on Fridays had a significantly higher risk of complications, hospital readmissions, and death as compared to people who had surgery on Mondays. Interestingly, the increase in adverse outcomes among the Friday group continued for one year.
- Schedule surgery for early in the day when outcomes are usually better. Research shows nighttime surgeries have more risks.
- Avoid surgery on major holidays, including between Christmas and New Year’s Day, when staffing levels are low. Also avoid the first week of January – a very busy time in most hospitals.
- Ask about staffing levels in the surgical unit for the time you plan to have your procedure. The standard rule of thumb is to have a one nurse for every 4-5 patients on medical–surgical units.
Interestingly, patients who received surgery on the surgeon’s birthday had a higher death rate compared with patients who underwent surgery on other days. Why? Perhaps surgeons are distracted on their birthdays. It might seem silly, but it can’t hurt to ask your surgeon about his/her birthday!
For more information, read What is the Best Time of Day for Medical Care?
5. Reduce your risk of surgical site infections.
SSIs occur in 2% to 4% of all patients having inpatient surgeries. Although most infections are treatable with antibiotics, SSIs are significant cause of harm and death after surgery, with approximately 3% of patients with SSIs dying. Additionally, SSIs are the leading cause of readmissions to the hospital after surgery.
Interestingly, a study, published in 2023, identified 8 key risk factors for SSIs after an abdominal hysterectomy. The analysis of records from 66,000 hysterectomies performed between 2015-2018 in NY found the following factors increased the risk of SSI:
- Obesity.
- Prolonged procedure duration.
- Patient age of 45 or younger.
- Diabetes.
- Wound contamination.
- Surgery via an open approach, versus a laparoscopic procedure.
- The presence of gynecological cancer.
- An American Society of Anesthesia score of three or higher:
- A 3 rating is given to patients with severe systemic diseases that are not life-threatening. (Note – systemic diseases are health conditions that affect one or more of the body’s systems).
- A 4 rating is given to patients with a severe systemic disease that is a constant threat to life.
- A 5 rating is given to patients who are “near-death” and not expected to survive without the operation.
Lead study author, Dr. Boldtsetseg Tserenpuntsag states the research team believes their use of a comprehensive dataset makes their findings more generalizable than previous studies on SSIs. In other words, their findings could apply to other types of surgical procedures.
How can you reduce your risk of an SSI?
Because of the potential harm, I suggest you follow these steps to reduce your risk:
- Using the study above as reference, ask your doctor if you have any of the risk factors that would increase your risk of SSIs.
- Ask your doctor if he/she recommends antibiotics before the surgery.
- Follow pre-surgical instructions very carefully, including prepping the area.
- If you have hair in the surgical site, do not shave. Instead, be sure staff shortens hair with clippers or removes it with a depilatory.
- Because staying warm can reduce the risk of infections, ask for a blanket for the pre-surgical waiting period.
- Be sure everyone — all visitors and the medical team — wash their hands before touching you or touching any hard surface you may touch. Importantly, if you do not see your doctors and other medical staff wash their hands, speak up!
- Wash your own hands regularly.
- Follow post-surgical instructions very carefully.
You can learn more at Safe Care Campaign.
Want tips on how to recover faster after surgery?
Of course, everyone wants to recover as quickly as possible after surgery. Fortunately, there are steps you can take — read How to Recover Faster After Surgery for more information.
Learn more tips regarding how you can improve your surgical outcome.
Surgery is serious. Your life might be at stake. Therefore, take the time to educate yourself to reduce your risk of complications and issues. For more information and tips related to surgery, read these posts:
- Questions to Ask Before Surgery.
- Questions Seniors Should Ask Before Surgery.
- Surgical Dangers – What You Need to Know.
- What is the Best Time of Day for Medical Care?
- How Safe are Surgery Centers?
NOTE: I updated this post on 3-5-25.