Consumer Guide to Elective Surgery and Procedures

Thank you for recognizing your pet may need to undergo an elective procedure such as spaying, neutering or dental work. Many people “shop around” for the best price on this surgery, without the knowledge of why the cost varies among veterinary practices. What is concerning is that some places charge a lot, but still cut corners on the care your pet receives. This guide was put together to help you find the best fit between the veterinary practice and your expectations for the care of your pet. I recommend you ask for details and a hospital tour before booking elective surgery and procedures for your pet.

1. What Preanesthesia Evaluation will my Pet have Prior to Surgery?
This is important for a number of reasons. A physical examination is our first defense against performing surgery on an animal that may have an infectious disease, a heart murmur, or be debilitated from parasites. A preanesthesia blood test can detect for hidden problems that could cause serious complications when the pet is under anesthesia or in surgery.

2. What Safety Precautions will be Taken with my Pet During Surgery?
While most surgery is uneventful, emergencies sometimes arise. Early detection of impending problems greatly aids our ability to intervene and correct the problem. An intravenous (IV) catheter will be placed prior to anesthesia induction. The IV catheter is our port for providing emergency drugs if there is an emergency. Having a catheter preplaced is one of the most important procedures for safety. Intravenous fluids will be administered to help maintain blood pressure, provide internal organ support and to help keep your pet from becoming dehydrated. A breathing tube should be placed (intubation) on all anesthetized animals. This keeps the airway open and allows for supplemental oxygen or gas anesthesia as needed. This tube is also very important to prevent aspiration into the lungs if a pet vomits or otherwise has excess fluids/materials in its mouth. If there is an aspiration, this causes a serious pneumonia. A respiratory monitor and heart (EKG) monitor allows the surgeon to keep track of heart rate and rhythm, as well as, the amount of oxygen in the blood. The practice should also have a “crash box” handy, which contains emergency drugs and supplies.

3. What Safety Precautions and Comfort Measures will be Taken?
Anesthesia and surgery patients lose body heat through anesthesia and the opening of body cavities. Warmth should be provided during and after anesthesia. If patients get cold, they become uncomfortable and their heart can be affected. Patient temperature should be monitored at regular intervals after surgery and supplemental heating provided as needed. Your pet’s gum color, pulse, and respiration should also be monitored. The IV fluids can be warmed to body temperature and the patient given adequate coverage to reduce heat loss.

4. How will Pain be Controlled for my Pet?
This is very important – surgery hurts! The anesthetic will NOT provide adequate pain control. Pain should be controlled before, during and after the surgery.

5. Will I Receive Written Post-Surgical Care Instructions for my Pet?
Aftercare of surgical patients is very important for proper healing. The hospital should provide written discharge instructions for your pet.

6. How can Services be Compromised to Lower Competitors Prices?
There are so many ways that care can be compromised for your pet. Although your pet may survive the procedure, greater risks may be taken. These risks are known to increase the chance of infection, pain, suffering and death. Since there are no laws that regulate these issues in Kentucky, some veterinary hospitals cut corners to be able to offer the lowest price possible. We firmly believe the clinics that cut corners are not adequately informing their clients of the risks involved. We believe owners should have choices and should not be disrespected if they cannot afford uncompromising care, but feel all pet owners should be informed that the LOWEST PRICE EQUALS THE CHEAPEST CARE. We have researched all the issues to develop our protocols. We believe our patients deserve uncompromising care.

The Facility

The patient should be prepared for surgery in a preparation area, not in the surgery room. This prevents hair and debris from possibly contaminating the surgery area.

It is expensive to have an area where only sterile surgeries are performed. So, if the surgery area is not a single use area, then infection rates are increased by increased traffic within the room. Performing surgeries or procedures that are not sterile surgeries in the surgical suite increases infection rates. Having a sink in the same room where the surgery is completed increases infection rates. Carpeting or poorly maintained flooring, ceilings and/or walls in the surgery room increases the infection rate as these can harbor debris, bacteria and viruses.

Preparation of the Patient

The patient should be examined and have a preanesthesia assessment. In most young, healthy pets, this is a simple blood test. In pets that are older or have other health issues, a urinalysis might be recommended. Chest radiographs or other evaluations may be recommended or required. To reduce the cost of procedures, these screening tests may be completely omitted in some hospitals. Abnormalities may not be detected until it is too late, or may make recovery after the surgery much harder on the pet and the owner.

Once the pet is in the hospital on the morning of the procedure, medications should be used to relax the patient and start the pain management program. Again, foregoing this step leads to a much more nervous pet, which increases the release of epinephrine in the system and can actually lead to increased abnormal heart contractions.

As noted above, the omission of placing an IV catheter, administration of IV fluids, intubation, and/or monitoring for respiration and heart rate and rhythm all reduces the cost of the procedure at your pets risk.

The patient should be aseptically prepared for surgery prior to being moved into the surgical suite. This includes clipping the hair, vacuuming the hair and debris and scrubbing the surgical site with special disinfectants.

Surgical Preparation and Attire of Surgeon and Assistants

Surgeons and assistants should prepare themselves to prevent contamination by wearing a surgical cap and mask. They should scrub their hands three times before donning a sterile surgical gown and gloves.

Surgical Instruments and Supplies

Surgical instruments should be sterile and of high quality. Using less than high quality instruments can lead to increased tissue trauma and pain, resulting in a longer healing time. The surgical pack of instruments should be used on only one pet, then cleaned, lubricated, repackaged and sterilized. Using instruments on more than one animal between cleanings and autoclaving can lead to an increased chance of infection and the spread of infectious disease. This is generally the case in most “low cost” facilities.

Surgical gloves are made to be disposed of after each surgery. In some hospitals, gloves are reused. The chance of microscopic holes in them drastically increases, leading to increased rates of infection and complications. Of course that is better than in the places that are not using gloves at all, or are using nonsterile exam gloves for surgery.

The choice of suture material varies greatly. The differences may not be readily apparent to pet owners that cannot compare differences, but those who have studied and tested the choices have published there are differences on both gross and microscopic levels. Some facilities reuse suture materials not used from a prior surgery. These materials have been dragged through the tissues of the prior animal and may be placed in a cold sterile solution until used again. Obviously, infection rates can be increased, as well as, tissue trauma. Suture materials may even weaken from such practices. Another cost cutting method is to use suture off a reel. This is an inexpensive way to purchase suture materials. These sutures are then rolled off the reel and threaded through a needle (which may have been used on multiple pets in the past and can be dull). The longer the reel has been in use, the greater the chance of contamination and risk of infection. Additionally, the suture that is threaded through the needle leaves a much larger hole in the tissue it penetrates. This increases tissue trauma, pain and healing time.

The alternative is to use suture materials that are prepackaged for single use and have a swaged on needle. The suture material is inserted into the end of the needle creating one smooth piece. This results in less tissue trauma and faster healing.

Suture selection also involves determining which material to use for a particular type of tissue. Some materials are not very strong and can lead to breakage of the suture or untying of the knots. This can result in dehiscence (or opening) of the incision. Certain types of suture can also cause increased inflammation within the tissues. These materials are very inexpensive. Better products have less reaction, which results in less pain and tissue trauma/inflammation and allows for faster healing and greater security.

The Surgery Performed

Most surgeries for spays and neuters are performed swiftly and with skill at most hospitals. We have mentioned many things that can change how the patient recovers after the surgery. The above-mentioned cost cutting choices have, in the past, and may still occur at some hospitals. In addition to comprehensive, quality care, we close the surgical site with hidden or buried suture patterns. Typically, the pet remains more comfortable because there are no ends to the sutures causing irriation at the surface of the skin. These sutures do not need to be removed, saving you time and a visit to the veterinary office. However, we do welcome any of our patients to come in at no charge to check the surgery site and/or for evaluation of any post surgical complications.

TRIVIA ANSWERS
A Group of Blue Jays is called A PARTY
An ALLIGATOR cannot chew
A litter of kittens is called a KINDLE
A CAMEL drinks that much
A RABBIT can run that fast