Transcription:

Bill Klaproth (Host): So, you are going in for orthopedic surgery. What questions should you be asking? Here to tell us is Dr. George Guild, Assistant Professor of Orthopedic Surgery at Emory University.

Dr. Guild thank you for your time. So, asking questions before any orthopedic surgery has immense value to the patient and I imagine the surgeon as well as it helps to have a well-informed patient. Is that right, Dr. Guild?

George Guild (Guest): Yes, Bill, that’s exactly right. There is good evidence that shows educated patients, when they understand the nuances of the surgery; really have better outcomes afterwards particularly with decreased pain and even increased function. And I think even with that conversation, you can really build a trusting doctor-patient relationship. So, all around, it can be beneficial. I agree with that.

Bill Klaproth: So, asking questions then a very good thing. So, let’s kind of go through this and the process of surgery. So, how about questions pre-surgery; what should people be asking you?

Dr. Guild: There are a lot of things that people want to know from how to prepare for surgery, what sort of even clothes they might want to wear to the hospital, what to do on the day of surgery with regard to medications. What to expect right after surgery with regard to pain level. If it’s a lower extremity surgery like a joint replacement; will they be able to put all their weight on their leg immediately? Will they need a walker or physical therapy? These are all pretty reasonable pre-surgical questions. And it’s also reasonable to ask your surgeon, do they do this type of surgery with frequency? Is this something that they do all the time? And I think those sorts of questions are valuable as well.

Bill Klaproth: Yeah, that’s really important. So, evaluating the surgeon as well and having that information. So, let’s talk about the procedure itself. There’s a lot of moving parts in that. What should they be asking you about the procedure?

Dr. Guild: Yeah sure, so standard questions I think beneficial for all parties would be what’s the length of surgery going to be? Is it going to be an hour, or do you expect five to six hours, if it is a particularly complex problem? What type of anesthesia will be utilized? It could be general anesthesia, but nowadays, we do a lot of cases under local or spinal anesthesia which can be safer. And then I think understanding some of the elements of the procedure particularly hip and knee replacements which is what I do the most of. I think when patients understand what we are doing, then things like what their activity limitations may be after surgery; they kind of understand why we are saying the things that we are saying. So, I think those are very valuable tidbits to glean from your surgeon.

Bill Klaproth: So, you just mentioned after surgery. Let’s talk about that. What type of questions about recovery are good questions to ask?

Dr. Guild: Most people, when they have anxiety before surgery, particularly elective surgery; they are concerned about how much pain they are going to have afterwards, and they are also concerned about are they going to be able to take care of themselves or if they are really going to be relying on friends and family members and things like that. And some surgeries, despite very contemporary pain management strategies, still require narcotic medications afterwards and you want to get an idea of what you should expect about your pain level. For someone who is having no idea of what their pain level expectation is ahead of time; they may have more pain than they expected before and I think you want to avoid that. And then the other part as I mentioned is are, they going to be as a patient, walking immediately, are they going to be walking 150 feet the same day? That’s usually true for what we do but if you live upstairs for instance, if you are going to be discharged the same day or the next day; are you going to be able to do stairs every day? Should you maybe be living on just your first floor for a week for instance? Are you going to be able to get food? Do you need to have meals prepared? Those are the kinds of social questions you want to have answered before the surgery.

Bill Klaproth: That’s really good information. And really important to ask those questions especially post-surgery because you may not be able to take care of yourself. So, great to ask those questions. You were mentioning pain level there as well. Let’s talk about medications prior to or after the surgery. What kind of questions should someone be asking?

Dr. Guild: The two most common we usually get are blood pressure medications and then what type of pain medications may be given afterwards. Usually, blood pressure medications – there are some you would not take the morning of surgery. Sometimes the anesthesia may keep your blood pressure low as is and so you wouldn’t want to double dip so to speak. And there are some blood pressure medications that we continue the day of surgery and so that’s something – many people take blood pressure medications. You want to have that ironed out ahead of time. And then after surgery for pain medications, we live in this era of an opioid epidemic and there’s been a lot of interest from the government on what we can prescribe, how much we can prescribe and so, I think just knowing some of those limitations are narcotics in this day and age is also very helpful.

Bill Klaproth: Very, very helpful. And what about risks and complications? What should people be asking you about those?

Dr. Guild: Well every procedure has certain complications that are often specific to the procedure. For an example, a hip replacement has potential low-risk for infection. I’m pleased to tell you that our infection rate is 0.28% which is the lowest in the country. We are very proud of that as an organization and a hospital. But knowing about that potential is very important. And your surgeon should be able to know what his or her infection rate is and give you an idea. It’s not the same for every surgeon and facility.

Other complications like for a hip replacement once again, could your hip come out of socket. There is a one in a thousand chance that can happen. Once again, these are very low risk items. But it’s the sort of thing you want to know about ahead of time so that if anything were to happen afterwards; your surgeon isn’t saying oh by the way I should have told you this could have happened ahead of time. So, other things particularly if you are having surgery on your leg; there is a five out of ten thousand chance of blood clots and that’s true for hip and knee replacement for instance. And you may need to take an aspirin as a blood thinner. So, the most important thing, whatever orthopedic surgery you are having, you want to just be aware of the specific complications that are possible. Fortunately, most of them are quite low, but once again, just having that knowledge ahead of time is very helpful.

Bill Klaproth: These are very important questions. So, how about follow-up visits and even long-term prognosis?

Dr. Guild: Yeah and this is a little bit of debate on how closely you should follow patients. Because we it both ways. Fortunately, the vast majority of our patients do excellent, 95-99% are having good, excellent outcomes for what we typically do. And if you have too many follow-up visits, sometimes people feel like heh, I’m doing so well, why do you keep wanting to see me? Occasionally we get that. That’s a good problem to have. But typically, for what I generally do; I see everyone after surgery at three weeks and then three months and then one year. And if anybody is having an issue in between, of course it would more frequent follow-up. And the other question comes up, we have a lot of travelers here as a tertiary referral center where people will come to us from out of state or travel a long way and that can be even tougher with follow-up and there are a couple of ways to manage that. Phone calls can be helpful. Pictures on the phone can be helpful. A local orthopedist might help you out. So, if you are travelling from out of town; it’s nice to be able to have some communications between us and their local doctor.

Bill Klaproth: Right and I know you do get a lot of questions, but I’m wondering do you ever say you know gosh, everybody always asks me these questions, but what they should be asking me is this. What would that question be if you could say to somebody, you know, what you should be asking me is this? What would that question be?

Dr. Guild: It comes up a lot of course because there is so much information on the internet, some is reasonable information from reputable sites. Some is potentially Suzy Q who had a one off and there’s all sorts of information that patients who may or may not be particularly familiar with the procedure are trying to sift through. So, I think for people who get particularly bogged down in what type of implant might be being used, are they going to have an allergy to metal; which can exist but is more rare. I would say if the patient is getting concentrated on very rare set of circumstances; then that’s probably not particularly useful. The most important thing is from a patient’s standpoint is what can I do to get the best outcome from my surgery and it’s usually improve your general state of health. If you are a smoker, you have to quit smoking. If you are a little overweight, maybe lose a little bit of weight. If you need to beef up on muscle tone, maybe physical therapy ahead of time, maybe pre-rehabilitation. These are all things that the patient has a certain amount of control over. So, kind of becoming the best version of yourself leading up to the surgery; this is the most important thing that somebody can do.

Bill Klaproth: Well being an informed patient is so valuable and you have given us some great questions to ask and things to understand before surgery. Dr. Guild thank you so much for your time today. For more information please visit www.emoryhealthcare.org/ortho, that’s www.emoryhealthcare.org/ortho. You’re listening to Advancing your Health with Emory Healthcare. I’m Bill Klaproth. Thanks for listening.