How do I find out whether a Surgeon's experienced / right for a particular op?

[smee]

Posted this earlier in Chat, but got no replies so am trying here instead.

My Dad has to have an operation to clear a major artery. I have googled his surgeon, but all I can find is the year he qualified. I'd like to find out how experienced he is in the type of surgery as it carries risks. Any ideas??

sorry for spellings..speed typing

Yes thanks giggle pin, I know exactly what they're going to do and it's a hugely successful operation in the main, which is excellent.

I'm concerned as there's a small chance he'll have a stroke during the operation or afterwards (about 3%). I'm also concerned by him having a General Anaesthetic at 76. As I mentioned above, the operation can be done under local anaesthesia, so I want to know why his Surgeon's not choosing to go that way.

Local anaesthetics are good until you actually get in there and the dog sees the rabbit.
If it becomes more invasive (and you dad may be asked to consent for more invasive surgery, if at the time of the operation they find he needs more) general anaesthetics becomes appropriate.
I am presuming here, but a general is better done in a more controlled manner, than in the midst of a procedure.
Your dad will be thoroughly assessed for suitability for general aneasthetic by an anaesthatist, not the surgeon.
What is he having done?

giggle pin, he had a minor stroke at Christmas, and an MRI found his carotid artery is 80% blocked on the left side, so it needs to be cleared. He has to have it done, but it does carry a risk. I'd googled a fair bit and discovered it can be done under local, which has the advantage that if he has a stroke during the operation they can tell instantly. Amelia then confirmed her mother had had the same op done that way. It's all made me wonder whether the Surgeon he has is the best one iyswim. They probably are, but I still want to check.

Your surgeon may have a minimum number of procedures thatbhe has to do each year to stay "current". Is the surgeon doing your a dad vascular? There may be a British Vascular Society that peer-reviews all procedures every year?

(reason I'm saying that is that DH is a cardio and his data for his procedures are reviewed every year by the British Cardiac Intervention Society. DH also has to do a min of 100 angioplasties every year to be regarded as currently trained).

Your surgeons dept should do their own internal audit of consultants every year. Number of new patients seen, complication rate etc etc. however, not every dept does this........

If you're getting nowwhere, you can write to the hospital's Surgical Director for an opinion.

With regard to your dad's GA, you can ask for an appt with the Neasthetist well in advance of the op to discuss anasthetic preferences/risks etc. From what DH says, 76 is not regarded as terribly old for a GA, if otherwise fit and well.

I think you are very wise to ask questions.

smee in terms of the GA versus the local, my mum was as you know not offered anything other. That surgeon does loads of these ops all the time. The reason for having a local is so that they can remedy any stroke immediately- so the patient is awake and can tell you what sensations they are feeling.

My mum's op was a day case. They kept her under observation then allowed her to go home.

She had her dressing checked and done at her local GPs about once a week.

It was nerve wracking for her, but when we looked into the stats, it seemed worth the risk. Her artery was 70%+ blocked on one side and something like 40% on the other. The risk of another stroke was high if it was left.

It took about 2.5 hours for the op- not easy on the patient but she is a tough old bird! She also had faith in the surgeon which helped.

sorry- repeated things you said, upthread.

Thanks Amelia, that's all really helpful. I've just had a chat to Dad about it and he's agreed we should ask a few key questions of the Surgeon. A big one is about the GA. I'd be far happier if he was having a local.

Highlander thanks to you too. Yes the Surgeon is Vascular, so I'll see if there are any peer reviews. If we ask the Surgeon our questions and he seems evasive, I will definitely ask higher up the food chain! Think you're right on the GA, but they do knock you sideways, so if he can avoid that it would be good. Also, as Amelia says if he's unlucky and has a stroke during the op they've no way of telling if he's under. Must be some logic to it all, but I will find out!

Just so you know- my mum's op took longer than they planned- it was a worse mess inside than he thought, so they had to go slowly and take very bit of plaque out.

I think she was quoted something like an hour to an hour and a half beforehand.

They have to be very careful not to dislodge anything that will travel round- and also of course they have to clamp off the artery and re-route the blood supply.

My mum was 80 ( or 79) and in good general health- normal BP and not overweight at all- so a GA was not excluded for that.

How does your dad feel about the idea of having an operation under a local anaesthetic?

amelia, sounds like your mum had a brilliant surgeon.

Blu, he's okay about it. He knows with a General he'll probably have to stay in and would rather avoid that if he can. He had stents before under local and said that was fine, so it's given him confidence.

OK just because he is reffered to a particulat consultant does not always mean that consultant does the op - it usually does but not always.

The choice of anesthetic should be dictated by the patient / procedure / medical reasons not a consultant's personal choice.

Comparing a good surgeon to a good teacher is completely useless. I work in education I used to work in health care.

Back in 1985-1995 patients in Lancashire / cheshire / cumbia could be reffered to one of two hospitals for heart surgery. But only one accepted smokers. So all smokers went to hospital A, non-smokers were split between hospitals A and B - guess which had fewer deaths post op and at 5 year follow up?

Are you sure this is an operation not a medical procedure? clearing arteries is often a medical procedure not carried out by a surgeon - if it is a surgical and it is something like an aortic resection then he will need a general anesthetic.

OK all that is irrelevant. Without your father's permsission you will find out zilch. Your best bet is to get your father an appointment and accompany him. Get the Dr to explain exactly what the procedure is, how many he/she has done, what the success rate is generally and any risk factors particular to your father such as general health.

If you can't get an appointment then make a request under the freedom of onformation act - how many of these procedures were done in the last two years, how many general vs local anesthetic, how many deaths etc.