Surgery

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Surgery is the field of medicine that focuses on operative treatments of the body. Although the technical skills to perform operative surgery are a fundamental part of surgery, these skills are secondary to a body of knowledge that comprises the core of surgical thinking. That knowledge includes human anatomy, a working understanding of hemostasis, wound healing, nutrition and all the aspects of normal physiology in the healthy patient, and pathophysiology in the diseased patient, that directly bear on achieving successful surgical treatment. Training in surgery includes operative training, and the diagnosis and treatment of disease in the surgical patient before and after surgery. The actual practice of a surgeon depends on specialty and subspecialty training, and the health care system in which the practice occurs.


Evidence-based surgery

"The turning point in the evolution of evidence-based surgery can be attributed to Ernest Amory Codman who, in 1910, began efforts to reform clinical medicine and surgery... Codman created a case monitoring system in 1900 to record outcomes."[1] His was the first system in which the outcome of a large number of individual patients were compared according to the operation performed, and the surgeon performing the operation.

Risks of surgery

The risks any surgical procedure include potential harm from the actual operative procedure, anesthesia and other medications administered, and postoperative complications from wound healing or restricted activity.

Patients undergo a counseling session to understand the risks and benefits of the procedure, and the treating surgeon must obtain informed consent before proceeding.

Anemia

Prophylactic iron or erythropoietin does not seem helpful in most studies.[2][3][4][5][6] One study found small improvement of uncertain clinical benefit at 6 weeks.[7]

Preoperative iron and erythropoietin may benefit patients whose mean ferritin is 40 to 43 mg/l[8] or have mild anemia[9] and others[10].

References

  1. Toby A. Gordon: Chapter 14 - Evidence-Based Surgery, in Greenfield's Surgery: Scientific Principles and Practice. 2006 Lippincott Williams & Wilkins Philadelphia
  2. Karkouti K, McCluskey SA, Ghannam M, Salpeter MJ, Quirt I, Yau TM (January 2006). "Intravenous iron and recombinant erythropoietin for the treatment of postoperative anemia". Can J Anaesth 53 (1): 11–9. PMID 16371604[e]
  3. Weatherall M, Maling TJ (December 2004). "Oral iron therapy for anaemia after orthopaedic surgery: randomized clinical trial". ANZ J Surg 74 (12): 1049–51. DOI:10.1111/j.1445-1433.2004.03265.x. PMID 15574145. Research Blogging.
  4. Madi-Jebara SN, Sleilaty GS, Achouh PE, et al (February 2004). "Postoperative intravenous iron used alone or in combination with low-dose erythropoietin is not effective for correction of anemia after cardiac surgery". J. Cardiothorac. Vasc. Anesth. 18 (1): 59–63. PMID 14973801[e]
  5. Weisbach V, Skoda P, Rippel R, et al (May 1999). "Oral or intravenous iron as an adjuvant to autologous blood donation in elective surgery: a randomized, controlled study". Transfusion 39 (5): 465–72. PMID 10335995[e]
  6. Sutton PM, Cresswell T, Livesey JP, Speed K, Bagga T (January 2004). "Treatment of anaemia after joint replacement. A double-blind, randomised, controlled trial of ferrous sulphate versus placebo". J Bone Joint Surg Br 86 (1): 31–3. PMID 14765861[e]
  7. Mundy GM, Birtwistle SJ, Power RA (February 2005). "The effect of iron supplementation on the level of haemoglobin after lower limb arthroplasty". J Bone Joint Surg Br 87 (2): 213–7. PMID 15736746[e]
  8. Lidder PG, Sanders G, Whitehead E, et al (May 2007). "Pre-operative oral iron supplementation reduces blood transfusion in colorectal surgery - a prospective, randomised, controlled trial". Ann R Coll Surg Engl 89 (4): 418–21. DOI:10.1308/003588407X183364. PMID 17535624. PMC 1963583. Research Blogging.
  9. Kosmadakis N, Messaris E, Maris A, et al (March 2003). "Perioperative erythropoietin administration in patients with gastrointestinal tract cancer: prospective randomized double-blind study". Ann. Surg. 237 (3): 417–21. DOI:10.1097/01.SLA.0000055275.38740.56. PMID 12616127. PMC 1514310. Research Blogging.
  10. Feagan BG, Wong CJ, Kirkley A, et al (December 2000). "Erythropoietin with iron supplementation to prevent allogeneic blood transfusion in total hip joint arthroplasty. A randomized, controlled trial". Ann. Intern. Med. 133 (11): 845–54. PMID 11103054[e]