Q: I have a 10-month-old Labrador, Otter, who recently had surgery for something he had eaten but could not pass. The veterinarian went in and removed the blockage from the intestine, and told us that everything would be fine. Well, it was not.
About a week after surgery, Otter developed an infection under the skin. He was very sick with a fever and a large, painful abscess had formed.
They took him back to surgery to drain and clean up the abscess. In addition to the added suffering of my dog, I was hit with an added expense. I don’t think that I should have to pay when this should have been done right the first time. What do you think fair?
A: As long as there are surgeries, there will be complications. The reason post-operative infections occur in a particular case can be hard to determine. But, in general, they fall into one of three general categories, which include the doctor, pet owner and patient.
That’s why it is so important to explain and be sure that owners understand the risks and potential complications before any surgical procedure. They must accept the fact that the outcome is not entirely within the surgeon's control, and that they, their pet and the condition itself also play a role.
The primary responsibility for minimizing wound infections rests with the doctor's team. Most surgical wound infections come from the patient itself, but they may be introduced in other ways. Generally, patients are given an appropriate antibiotic before and during surgery. The surgical site is then prepared according to prevailing surgical standards. The surgical team also dons protective gloves, caps and masks, and adheres to strict sterile technique. When everything is done properly, the risk of infection is minimized, but it is never 0 percent.
The patient itself also influences post-surgical outcomes. The overall health status of pets varies widely, as do the conditions for which they are having surgery. Some have better immune systems than others, and the presence of concurrent medications or health problems, such as diabetes, cancer or other endocrine disorders, can have a significant impact upon resistance to infection and the ability to heal.
Likewise, a patient's behavior can affect outcomes. Pets that are difficult to confine, or that have a tendency to lick or chew at their wounds, tend to have higher rates of wound complications and infections.
The pet owner must understand and follow post-operative care instructions to the letter. They have to monitor for signs of complications and report them promptly. Failure to limit activity, prevent licking at the wound or maintain a proper environment can all contribute to wound issues.
In Otter's case, there was a piece of foreign material obstructing the intestine, which was surgically removed. So, no matter how sterile the surgery was to begin with, the veterinarian then had to cut open the intestine. This is, in effect, opening up the sewer in the middle of a sterile field. No matter how careful the vet was, some bacterial contamination occurred.
These type of surgeries are referred to as clean-contaminated, because they begin clean and become contaminated. Protocol dictates rinsing the abdomen with sterile saline to wash out anything that may have spilled, but it is not likely to remove every bacterium.
Hopefully, the antibiotics will catch what’s left. Antibiotic resistance, however, is a growing problem for people and pets, and nowhere is this more of an issue than surgery. While the antibiotics we use in surgery will get most bacteria, the prevalence of resistant bugs is growing.
After intestinal surgery, antibiotics are often discontinued. This is simply because we worry that the intestine can leak after surgery, which can be fatal if not quickly identified and corrected. Antibiotics can delay recognition of a leak, and thus delay life-saving intervention. So, the risk of a nonlife-threatening-wound infection is increased, in order to reduce the risk of a fatal outcome.
As to the question of what is fair in this case, I (Henri Bianucci) don’t have enough information to say. All I can say definitively is that Otter had a surgery that carries an overall wound infection rate of about one in 20. That’s assuming everything is done according to current medical standards.
Patient, doctor and owner factors can all affect the odds, for better or worse, but none can guarantee an uncomplicated course. In cases with costly complications, the best resolution begins with a rational and honest discussion of the facts of each individual case.