Risks Of Surgery Before A Year Old Vs After Baby The Risk of a Stroke During Plastic Surgery

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The Risk of a Stroke During Plastic Surgery

Unspoken Concern

While most plastic surgeons will outline the risks of performing an elective surgical procedure, very few tend to speak directly to the issues of safety and post-operative complications. Often, a surgeon will make a general statement about the risks of surgery, such as, “All surgery carries risks that include, bleeding, infection, difficulty breathing, swelling, clotting, and other ailments in a small percentage of patients,” and then move directly into talking about the benefits of the procedure. Patients should inform themselves about the real risks associated with cosmetic surgery procedures, especially the risk of stroke or cerebrovascular accident (CVA). As a doctor, I understand that it is not worth scaring our patients for no reason. However, I still firmly believe that patients should never be too quick to decide on an elective surgical procedure without fully realizing the potential for devastating complications.

Patients and doctors should recognize that most patients who receive some form of cosmetic care are generally considered to be healthy individuals. Thus, neither patient nor doctor is necessarily prepared for the onset of a complication. This fact alone can make a complication far more serious than if the same complication arose during a medically necessary procedure. For example, even during routine knee surgery, doctors do not see their patients as completely healthy, and are more guarded against the appearance of blood clots or other risk factors for stroke.

While the approximate one to two percent of cosmetic surgery patients who will experience a stroke seems like a very limited number of patients, the effects of these strokes can be devastating.

Who is at Risk?

Few patients really consider themselves at risk for a possible stroke because they associate the condition as an event that happens to people over 55 years of age. While in some cases age plays a factor, it is far from the determining factor of stroke. In fact, a healthy 65-year-old woman may be less likely to have a stroke than a 35-year-old woman who undergoes invasive cosmetic surgery. Patients should understand the causes of stroke in a postoperative setting to more realistically assess their level of risk. However, as a physician I can attest that sometimes there is simply no way to tell why a stroke occurred for one individual and not another with the same health history, the same risk factors, and the same surgical procedure.

Most postoperative strokes occur when a blood clot dislodges, which typically occurs in the lower part of the body. That blood clot then travels through the body and can lodge in the brain or more often the lungs. This action of a blood clot traveling through the body after surgery is often referred to as an embolism and usually arises from a larger blood clot that usually forms in the lower body known as a deep vein thrombosis or “DVT”. DVT is a major concern for surgeons, and can be considered a precursor to stroke.

Understanding the Potential Danger

Blood clots generally get trapped in either the lung or the brain when they break free from other parts of the body. When the blood clot becomes trapped in a blood vessel in the brain, it results in a CVA or stroke. When it becomes trapped in a blood vessel in the lung it is known as a pulmonary embolism or PE. Both conditions are life-threatening and can have serious consequences.

While blood clots and strokes are a significant risk for all patients having any type of invasive surgery, plastic surgeons face a unique scenario that generally makes it a bit more difficult for our patients to receive treatment and help in a short amount of time. Events of blood clots and stroke can occur anywhere from several hours post-operatively to approximately ten days post-surgery. Thus, these events rarely occur within a medical setting and usually occur at home. Patients who remain in the hospital or medical center after a medically necessary procedure are more likely to have these events in the hospital.

Patients who are going to undergo a cosmetic procedure or any type of surgery for that matter should familiarize themselves with the general symptoms of post-surgical pulmonary embolism or stroke. Symptoms that include shortness of breath, chest pain, disorientation and sometimes even a sense of altered mental status are likely related to a pulmonary embolism or stroke. Patients and physicians alike should understand the basic risk factors for these complications and before a surgical procedure. Although studies are still being conducted that will help determine a patient’s risk level in the future, there are some fairly basic factors that point to a likely candidate.

Risk Factors For Patients

Women are more likely to experience these types of complications than men, as are smokers. There are many medications that put patients at a higher risk for postoperative blood clots, including but not limited to hormone replacements and birth control pills. Weight plays an important factor as does the level of activity that the patient generally participates in. Patients who generally lead a sedentary lifestyle are at higher risk. Obese patients have an even higher risk. Increased age and a previous history of deep vein thrombosis are more obvious risk factors. Patients who have a current diagnosis of cancer are at particularly high risk.

Reducing the Risk Factors for Safer Surgery

Whenever a patient is booked for surgery in my practice, I always insist that they have medical clearance from an internist to help determine their overall risk level for elective surgery and the potential for medical complications, which include the risk of abnormal blood clotting. I also consider the type of surgery I am performing on the patient. In general, surgical procedures that have a longer operating time and involve body contouring carry a higher risk than those that are minimally invasive and are performed on the head and neck. The internist will review a list of current and recent medications, as I do myself, and verify that the patient is physically able to tolerate the desired procedure. There are still no guarantees, but knowing a patient’s medical history, their obvious risk factors, and having a second pair of eyes look at the same information I’m presented with ensures that I take every possible precaution.

I also use something known as pneumatic compression boots for every patient undergoing any surgical procedure and I encourage other doctors to do so as well. These boots are able to keep the muscles of the lower extremities moving in a fashion similar to walking, which can help prevent blood clots. I insist that my patients maintain an active lifestyle, to help prevent DVT formation and directly assist with pre-operative and post-operative care. Proper positioning in the operating room allows additional prevention of blood clot formation as well.

Doctors and patients need to understand that the potential for serious complications related to cosmetic surgery can be devastating. Knowledge is power and education can help reduce the number of blood clots and such rare but devastating complications as strokes that occur after surgery. With current research and educational practices, we should be able to reduce the number of postoperative strokes and blood clots for years to come.

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