Elective Surgery – Should You Or Shouldn’t You?

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One Saturday, just before noon we saw the final appointments of the day. We all wanted to enjoy our weekends so no surgeries were planned on Saturdays. When the phone rang, everything changed.

A logging truck had hit an American Eskimo, and that’s the truth!

The usual materials for emergency care, such as radiographs, instruments and other equipment were set out and we prepared to manage critical patients. Our patient was conscious, and we were able to determine that he suffered from a fractured pelvis, a fractured femur, and other internal injuries.

Before we could begin the orthopedic repair, the patient required immediate surgery to fix the internal damage. The patient had a bladder rupture, which was repaired. After several hours of surgery the patient started a smooth recovery.

The case presented here is an example where surgery was necessary to save the life of the patient. But there is a completely separate type of surgery that doesn’t qualify as “necessary.” The term elective surgery is used to describe surgical procedures performed by choice. In other words, elective surgery can be done. The surgery does not need to be performed to stabilize or save the life of the patient.

All of us are aware of the most common elective surgery performed on humans – liposuctions, mole removals, and facelifts, to name just a few. In dogs, the most common are ear cropping and spay/neuter surgeries. The majority of people believe that ear-cropping is only a cosmetic surgery with no medical benefits for dogs. It’s important for dog owners to consider carefully whether they want to go ahead with an elective surgery. Many of these surgeries, while not life-saving may still have health benefits.

Dog owners and vets are faced with a dilemma when deciding whether to perform surgery or not. Most veterinarians recommend that fat growths, or lipomas as they are called, be removed once they have reached a certain height. If left unchecked, these fatty deposits can grow to enormous proportions. Which fat growths should be removed and which can be left? Some fat deposits will continue to grow even if they are benign and have been tested and analyzed by needle biopsy.

Risks vs. Benefits

What are the benefits and risks of a particular procedure? Take dental procedures as an example. You could argue that if loose teeth, deep infections, or gingival swellings are present, the procedure is necessary to protect and improve the quality of the patient’s life. These elective dental procedures aren’t without risks, however, as they require anesthesia or surgical intervention. Modern veterinary presurgical protocols can minimize the risks. One tool that is used to identify “at-risk” patients is the assessment of blood chemistry profiles.

Pre-anesthetic screening of blood is essential, according to Dr. Rhonda Scholman, a vet at the University of Illinois Veterinary Teaching Hospital, in Urbana. While most animals in good health are not at risk of complications from elective surgeries such as neutering or spaying, it is possible that the animal has an underlying condition that may only manifest when the animal goes under anesthesia. “Surgery is not the time to find out that you have a problem.”

Before performing any elective surgery, veterinarians will always talk to the owner about the risks and benefits of the procedure and how they can minimize the risk while maximizing the benefits. The timing is crucial in many cases. If cancer surgery is done in the early stages, it can have long-term benefits. However, delays due to lack of decision may undermine the effectiveness of the surgery. Orthopedic issues such as torn tendons, broken bones, cartilage damage, and progressive arthritis can be irreversible if surgery is not performed immediately.

Michael Bauer, DVM is a specialist in surgery at Veterinary Specialists of Southern Colorado, located in Colorado Springs.

If the issue is one that will likely progress until the surgical procedure fails, it’s important to act quickly. Anterior Cruciate Ligament tears in dogs are a good example. ACL tears in dogs are often followed by debilitating and progressive arthritis. Early surgical intervention is crucial because ACL repair does not require joint replacement, but relies on the condition of the joint.

Bauer says that the choice to perform surgery is based on how severe the clinical signs are and the quality of life of the animals. This is illustrated by total hip replacements for dogs suffering from hip dysplasia. An artificial hip will likely be successful, regardless of how severe the arthritis is. The arthritic joints are being replaced. If the dog’s clinical symptoms are not significant, we will never recommend a hip replacement. If we decide a total hip replacement on your dog is necessary, we will prefer to perform the surgery as soon as possible. “Why make your dog suffer with a painful or uncomfortable hip an additional year, when total hip replacement can provide almost immediate results?”

Bauer urges clients to think about the cost, the quality of the animal’s life at risk and the likelihood that the issue will worsen until the surgical fix is no longer effective. Bauer also says that anesthetics are only a concern in unhealthy animals. With today’s monitoring and anesthetic equipment, and a blood chemistry test done before surgery, the risk of anesthesia is very minimal.

The dog owner will make the final decision based on the information they have gathered. The risks associated with the operation will depend on the goal and the anesthesia required.

Is it necessary to spay (or neuter) your dog? Is it necessary to remove that lump before it becomes a cancerous growth? Is bad breath a sign that a dental treatment is required?

Understanding the risks, weighing the pros and cons and collecting patient information are the best ways to answer these questions. Even though your decision may not seem as obvious as a life-saving surgery for a dog that was run over by an emergency logging truck or a life-enhancing procedure on the dog, you can still be confident in the fact that you are doing the right thing.