To be nervous about my child having an operation in a private hospital

[elliejjtiny]

Tbh I'm nervous about this operation in general and we've known since he was born that he would have to have this operation and he is now 10 so that's a lot of nerves.

Ds is 10 and has had lots of operations already (20+, I lost count in the end). This one is quite major and he will be in theatre for 3 hours. Ds's normal surgeon is off sick for the foreseeable future so they've brought in another surgeon. We have met him and he seems nice but he does his operations in the private hospital, including the nhs patients, rather than in the children's hospital where ds's usual surgeon works.

For his first operation, which is similar to this one and the same length, ds needed to be in hdu for a few hours afterwards as he took longer to wake up than expected. The private hospital doesn't have a hdu for children, just 3 adult icu beds so he would have to be transferred to the children's hospital about 15 minutes drive away if he needed hdu. The surgeon said if he'd needed hdu in his last operation then this one would be done at the children's hospital just in case but as he has had other operations in between them it wasn't necessary. I asked if he could have the operation at the children's hospital anyway for my peace of mind and was told no. At his last operation (which was also 3 hours) he was really sick multiple times despite having the max dose of ordansetron. He was in the day surgery unit of our local hospital and they sent him home after an hour on the ward, still vomiting and so sleepy that he had to be brought out to the car in a wheelchair. I told the surgeon this and he said the private hospital can cope with that.

Ds is actually quite excited about the operation, mainly about having time off school, being fussed over and getting ice cream afterwards. Obviously I'm not letting him see I'm worried. My in-laws keep saying that it's great that we're in a private hospital and I should be grateful etc and I am but tbh I quite liked being on a ward last time with other children having the same operation. Also I would feel safer at the children's hospital. Ds also has learning disabilities which makes me nervous and he usually has a play therapist go down to theatre with him. We also always know the staff at our local hospital and the children's hospital which I always find reassuring. He has had a few operations where they have had to put him under kicking and screaming and I'm scared of potentially having to do that without help from the play therapist. I know they have peadiatric nurses at the private hospital but not sure about play therapists etc.

@elliejjtiny really. That's a surprise. No way would I want that done I a private hospital. We do loads every month and k ow what we are doing. A private hospital won't do many to keep skills up.

elliejjtiny

Thanks, she's doing ok. She didn't struggle too much with the diet, lots of ice cream, yoghurt and porridge! It's been more the lack of activity and pain in her hip, which they did say would probably be worse than the pain in her mouth. We have a follow up tomorrow with the surgeon though as unfortunately she lost a piece of the bone from the site but I'm hoping the graft will still take.

I hope everything goes well your son, whatever you decide regarding the hospital. I understand your apprehension though, when you've built up a relationship with a particular hospital and surgeon it's difficult to go somewhere else.

It's always the hip that causes more pain. We have started doing ABG's as day cases now. Which I have very mixed feelings about!

Toddlerteaplease

Yes, I was encouraged to take my little girl home that same evening, despite her only leaving the theatre at 3pm. I wasn't impressed and insisted she stay in. Her pain and recovery that night was quite bad. Not quite sure how a same day discharge is in the child's best interest!

@ZellyFitzgerald I completely agree. Particularly as some of our children live up to 60 miles away. And have already had a very early start in order to get to us for 7.30. Our network covers an enormous geographical area.

Some repairs of incomplete lips are also day case now. Not keen on that either, as some babies initially feed really well as they are ravenous. And then as the LA wears off they need morphine for the pain. And parents often struggle with their babies change in appearance.

I wouldn't be happy about either ABG or lip repair being day surgery. I remember after ds lip repair we were moved back to the main bay with 14 (I think) beds/cots in it. Ds was still quite sleepy but the other babies having cleft operations were crying most of the night. After his palate operation they gave him morphine and tramadol while he was in hospital and he wouldn't have coped without it.

Yes. They tend to beed a dose of morphine around 9pm, when the local anaesthetic wears off. Cleft nights can be very noisy!

So today we got a letter from the private hospital saying that we have a date for ds operation. It's day surgery though instead of overnight which is making me more nervous. We also have a pre op booked in with one of the paediatric nurses, either in person or on the phone but we haven't got a date for that yet.

To be honest if it’s day surgery then it sounds much less complex so I would be reassured by that.
I would never choose for my child to have an inpatient stay in private care. They are just not set up for it. But for outpatient it should be absolutely fine and pre-assessment will be reassuring because it would flag any concerns to the anaesthetist. So if they’re happy then I’d feel reassured.

Thank you. I am concerned about how his pain can be managed at home as when he had a similar operation when he was 1 he had tramadol and morphine during the night in hospital. He was also on a drip because he wasn't drinking anything.

No experience of children in private hospitals, but I was sent to a private for an op last year. It was nothing like NHS, the standard of care was so much higher.

Same for me. I was treated like royalty

Was amazing the care. The constant nurses popping in etx

If the surgeon feel your son will be ok at that hospital then Trust his judgment

We do some ABG's as day surgery. (They used to be in for several days) Many of the kids stay overnight, as they just aren't ready to go home. And many of them live a long way away, so would struggle with a two hour car journey. Our cleft region is a huge geographical area. No one is pressured to go home. If there is the slightest concern about going home. You stay. Have you spoken to your cleft nurse OP?

@Calamitousness Its big surgery.

Thank you @Toddlerteaplease I hadn't thought about speaking to the cleft nurse. I just panicked and all rational thought left my brain! I know things change over time and it's been 9 years since his palate operation but I've seen children have ABG surgery while ds was having his lip and palate operations and some of them were on morphine pumps. Ds also has learning disabilities and falls over a lot so I'm worried about how his mobility is going to be afterwards.

We would not routinely put an ABG in a PCA. As they have a local anaesthetic block to the hip instead. Years ago one of our surgeons used local anaesthetic infusions for a couple of days, and the kids were NBM. But he changed his practice, when he realised the kids with a block, did better. The kids who need PCA's are Buccal flap, or other palate surgeries, that I can't spell! But they tend to be 4-5 years old.

My now adult son had his adenoids out at the age of two. The surgeon who we had seen at a private hospital said he would only operate on a child at a general hospital which had a blood bank. I don’t know if this is still a recommendation and know there is a huge difference between two and ten.

Cousin works for one of these 'contract' type hospitals. Most of the staff have many years experience, all are fully up to date on training and qualifications.
She tried to arrange for me to have an op there. Didn't need it though luckily.

@Toddlerteaplease I know exactly the surgical procedure. And yes it’s not a low complexity procedure but neither is it high either. The condition of the child being able to manage with a day surgery stay would indicate he has no other co-morbidities of concern and he is 10 so a good size. The main worry I would have around ABG is ensuring the pre and post care is in place to try and support engraftment.

@Calamitousness yes it does need to be managed very carefully

I would ask who the anaesthetist is and do they have peads ITU experience. If so I would be happy as worst come to the worst the poor anaesthetist isn't going home until he's transferred. Having had surgery in the NHS and private I would pick private. The 1:1 care was outstanding. I'm also a pain to wake up + get my sats back up. Just means longer in recovery. DS on the other hand is very awake very quickly so hard to get to rest .

Its doesn't sound like a pleasant surgery but also not excessively high risk.

Just updating to say that we have a pre op telephone appointment tomorrow with one of the paediatric nurses. I've been writing a list of all his operation dates and any post surgical complications. Are there any questions I should be asking?

My kid had a GA OP at private hosp. It wasn't long or invasive.
But the children nurses were epic and he loved it - private room and proper nice cooked meal afterwards. This was height of winter lockdown so it was a nice day out for him 😂

Thank you. When we had the pre op with the nurse from the private hospital we were told that they only take children with no other conditions and they hadn't been told about any of ds's other problems. So we are back on the waiting list. We had another appointment with the team from the children's hospital and they said he has to have teeth out, then ABG in 2 separate operations rather than all together so we are waiting for that now.

Oh that's so frustrating for you. It drives me mad when basic information like that isn't communicated, leaving you and DC waiting for even longer.