Surgical Risk and Judgement

Classification of Physical status of the Animal

It reflects an attempt to define the condition of the animal and thereby surgeon becomes alert to problems which may occur during anaesthesia and surgery.

Physical status may be of-

1. Good
2. Fair
3. Poor
4. Extremely Poor
5. Emergency Good
6. Emergency Poor
7. Moribund condition

Surgical Risk

The term surgical risk is used to describe the animal’s potentiality for surviving anaesthesia and surgery.

To reduce the risk to minimum is of surgeons concern and alert to problems that may arise during anaesthesia and surgery

Factors influencing Surgical Risk

• Haemorrage and shock
• Fluid and electrolyte imbalances
• Acidosis and alkalosis
• Anemia and hypovolaemia
• Malnutrition and hypoproteinemia
• Pulmonary and cardiovascular complication
• Hepatic insufficiency
• Renal and adrenal diseases
• Obesity of the patient
• Extreme of age – complication in both very old and very young animals

How Surgical Risk is determined?

• Detailed history of animals
• Physical status and condition of animal
• Individuality
• Clinical examination of the patient including general, systemic and special examination
• Essential laboratory examination including routine examination of stool, urine and blood (clotting time, bleeding time, total count, differential leukocytic count, haemoglobin %, packed cell volume)
• On the basis of magnitude of operation, nature of aliment with foresaid findings, the risk of patient is evaluated

Adjuncts and Safeguards-

• Evaluation of operative risk
• Recognition and correction of preoperative deficitsPrevention of intra-operative and postoperative complication before they develop
• Resuscitation and after care of surgical patient

Surgical Judgement-

1. Surgical judgment is something that can be developed only over a period of time, the length of time depending on the surgeon’s exposure to many and varied cases.
2. A Surgeon who continuously makes the same errors can never develop sound judgment.
3. When examination and diagnosis favours or indication for surgical treatment then decision must be made about:
   • Feasibility of performing surgery in consideration to the animal’s condition.
   • When to undertake surgery
4. Feasibility of performing surgery entirely depends of the evaluation of the patient but the proper timing of operation is more of a problem in clinical judgment then the decision as to performance.
5. The decision must be based on the circumstances and the optimum condition of the patient for surgery.
6. Such type of decision as to whether and when to undertake surgery is applicable both for emergency and elective surgery.
7. In elective surgery certain preoperative schedule should be carefully followed and evaluated.
   • Careful recorded history
   • Detailed physical examination
   • Essential laboratory test
   • Radiographic study where necessary
8. Other diagnostic test like ultrasonography, computed tomography, doppler study, magnetic resonance imaging etc., wherever required
9. Emergency surgical operations are those where there is serious injury or massive internal hemorrhage which may endanger the life of the patient.
10. In such cases the preoperative preparation must be limited to be rare essential.
11. It is never justified to omit the details of a careful recorded history and careful physical examination treatment of preoperative preparation of emergency cases.
12. Resuscitation, emptying of stomach, empting of bladder by catheterization should be considered as general rule, if necessary.