Consumer guide to elective surgery and procedures

   When your pet needs to undergo anesthesia and have surgery or a dental procedure you may become nervous about the risks and potential outcome. Obviously, safety becomes a foremost concern. Unfortunately many people "shop around" for the best price on a procedure without knowledge of why the cost may vary among veterinary practices. Often a lower cost procedure is associated with fewer safety precautions and infection controls and may cost less, but puts the patient at greater risk. Below are a few questions designed to help you to find the best fit between the veterinary practice where your pet will receive their procedure and your expectations for the care of your pet.
What preanesthetic evaluation will my pet receive prior to their surgery/procedure?
It is important that every patient have a physcial examination before undergoing anesthesia as this is the major protection against placing a patient under anesthesia that may have infectious disease, a  heart murmur, or be debilitated by parasites.  Preanesthetic blood testing is important as well as these tests can detect hidden problems, such as mild decreases in liver or kidney function.  This is very important because most patients with early disease show no outward signs, yet the stress and internal changes associated with anesthesia can worsen an already existing problem that has not been recognized yet.  If abnormalities are found, the patient's procedure may be postponed, or modified to minimize risk or complications.
What safety precautions will be taken with my pet during surgery?
While most surgery is uneventful, emergencies sometimes arise.  Early detection of impending problems greatly aids our ability to intervene and correct the problem.  You will be encouraged to have an IV catheter placed in your pet's leg prior to anesthesia.  The IV catheter is a port for providing emergency drugs if there is an emergency, and allows us to administer IV fluids to help maintain blood pressure, provide internal organ support and to keep the patient from becoming dehydrated.  Having a catheter preplaced is one of the most important patient preparation measures.  A breathing tube is placed that allows for oxygen and anesthetic gas to be administered.  The tube is also very important to prevent aspiration into the lungs if a pet vomits or has excess fluids in it's mouth.  If aspiration occurs and no tube is in place, this can cause a serious pneumonia that can even result in death.  An respiratory and EKG monitor is attached to the patient to keep track of heart rate and rhythm, as well as the oxygen levels in the blood.
What comfort measures will be taken with my pet during surgery?
Patients that are under anesthesia for surgery/procedures lose body heat and are at risk of developing hypothermia.  Patients that become cold will not only be uncomfortable, but decreased body temperature can also affect the heart and it's function.  Patient temperature should be checked at regular intervals and supplemental heating should be provided, as needed.  An IV fluid warmer should be available to warm the IV fluids that the pet receives during the procedure.
How will pain be controlled for my pet?
It is very important that pain medication be used for your pet, because surgery hurts.  Research has shown that animals feel pain during sugery, just like we do, they are just better at hiding their outward response (likely an adaptive response from before they were domesticated).  Anesthetic medication will not provide pain control once the pet wakes up.  For adequate pain control the patient needs pain medication before, during and after the day of surgery.
Will I receive written post-surgical care instructions for my pet?
Aftercare of surgical patients is very important for safety and healing.  You should receive written discharge instructions for your pet that details things to expect and how to know if your pet may need to be checked for postoperative complications.
In what ways can services be compromised to lower competitors prices?
There are many ways that corners can be cut.  Although your pet may survive the procedure, greater risks may be taken which increase the chance of infection, pain, suffering and even death.   Some hospitals will cut corners to be able to offer the lowest proce possible.  Unfortunately if consumers do not know the types of corners that can be cut and the right questions to ask, they will not be adequately informed of the risks involved.  Owners should have choices and not be disrespected if they cannot afford uncompromising care, but do need to realize that the lowest price probably means the lowest service.
 
The patient should be prepared for surgery in a preparation area, not in the surgery room.  Preparing the patient in a separate area prevents hair and debris from possibly contaminating the surgery area.  It is expensive to have an area where only sterile surgeries are performed.  If the surgery area is not a single use area, infection rates are increased by increased traffic within the room.  Non-sterile procedures, such as dental procedures should not be performed in the surgery room as this increases infection rates.
 
Before surgery,  the patient should be examined by a physical examination and preanesthetic screening.  In most young, healthy pets this is a simple blood test.  In pets that are older or have known health issues, more extensive testing may be required.  To reduce the cost of procedures, some hospitals may not even offer these services.  Abnormalities may then not be detected until it is too late, or may make recovery after the surgery much harder on the pet and owner.
 
Once the pet is in the hospital the morning of the procedure, medications should be used to relax the patient and start the pain management program.  Forgoing this step may be cheaper and allow a hospital to quote a lower price, but leads to a more nervous pet, which increases the release of adrenaline into the system and can lead to abnormal heart contractions.
 
Not placing an IV catheter, not administering IV fluids, not intubating the patient, not having monitoring equipment to monitor vital signs may decrease cost, but puts the patient at greater risk.
 
The patient should be clipped, vacuumed free of debris and special disinfectants used to prepare the surgical site before transfer to the surgical suite.
 
Surgeons should prepare themselves to prevent contamination by wearing a surgical cap and mask.  They should scrub their hands with surgical scrub and water before donning a sterile surgical gown and gloves.  A new set of sterile gown and gloves should be used for each patient.  One way corners are cut is to wear the same gown and gloves for mutliple patients.  This saves on time and money, but puts patients at risk for disease transfer and should not be done.
 
Instruments used should be of high quality and well cared for.  The surgical pack of instruments should be used only on one pet, then cleaned, lubricated, repackaged and sterilized.  Using instruments on more than one animal between cleanings and autoclaving can lead to increased chance of infection and disease.
 
Surgical gloves are made to be disposed of after each surgery.  In some hospitals, gloves are reused and the chance of microscopic holes in them drastically increases, leading to increased rates of infections and complications.  Even worse is places that are using no gloves at all, or even non-sterile gloves for surgery.
 
Most surgeries are performed swiftly and will skill at most hospitals.  Some of the shortcuts we have mentioned above can affect the patient after surgery even if the typical pet owner cannot appreciate the difference.  Many hospitals are dedicated to excellent patient care and do not employ shortcuts, however, some of these have been used in the past, and may still occur at some places.  We do not cut corners, because even though it would allow us to charge lower prices, it would put our patients at greater risk.  We also close most incisions with hidden or buried suture patterns (for most elective procecures) so the pet does not have to return for suture removal, saving stress and time.  We also do not give prophylactic antibiotics to cover for sloppy service. 
 
Before you have your pet undergo anesthesia, it would be wise to ask about some of the above topics to be assured that your pet has the best and safest experience possible, not simply the cheapest.