Wednesday, February 4, 2015


If you don't get complications, you don't do enough surgery - every attending's motto when I was a resident. Back then, I was sure complications were an excuse to torture us at M&M.

Complications suck. I hate them. I hate being on the other side of them (the last surgery on me had a post-op complication). But there is no way to COMPLETELY eliminate complications.

You can reduce them - certain post-op infections without prophylactic antibiotics approach 25%. When I give pre-op antibiotics, less than 2%. But it is still a number larger than 0. Post-op DVTs can occur in up to 1/3rd of all women undergoing hysterectomies, according to the literature when I was a resident. With SCDs and anticoagulation, we can greatly reduce - BUT NOT ELIMINATE - this complication.

Distorted anatomy can easily cause iatrogenic injury. Endometriosis, previous surgeries, large fibroids, severe pelvic prolapse can all change anatomy. I have transected a ureter because of endometriosis. I have injured bladders because of scarring from previous c-sections. The key is recognition and awareness.

It's hard. We surgeons all like to think we are the best at this - it's how we got here. We all hate having a patient experience a complication.

As I told my ortho - who was feeling horrible for me - I was the best person for a complication because I understood.

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