During Your Surgery
I'm afraid to get someone else's blood. Is the blood supply safe? What are my options for getting blood?
Though the process of giving blood transfusions is generally safe, even with our many precautions reactions after transfusion occasionally occur. These transfusion reactions are at times mild immune responses that require little treatment, such as fever, chills or hives. Patients may develop antibodies complicating there receipt of blood in the future. Even more rarely, potentially serious events like disease transmission, the destruction of red blood cells (hemolysis) and complex or exaggerated immune responses do occur, though they are seldom life threatening.
If your surgery is expected and your condition and time allow, you have options other than receiving blood from the blood donor pool. One option is to have some of your own blood drawn and stored for use during your surgery if you should need it. This process is called autologous blood donation and transfusion. Currently, for some surgeries, a machine can be used during the operation that collects autologous blood from the surgical site and processes it during the case for return to the patient. This machine is called “Cell Saver”. Lastly, there is the option of directed donation from a friend or relative.
Overall, your risk of a problem from blood transfusion is very low. We hope this explanation of your options gives you confidence as you approach your procedure.
After Your Surgery
Our Anesthesiologists and the staff in all our practice locations are committed to giving you the best possible operative experience. Current medications for the prevention and treatment of post operative nausea and vomiting are highly effective. Most people come through surgery comfortably and without nausea. There are a variety of medications and anesthetic techniques used to prevent and treat nausea if it does occur.
Depending on your procedure and history you will receive an appropriate preventive anti-nausea treatment. These measures are effective over 90% of the time. Occasionally, there are patients who develop nausea even after preventive measures and medicines. And only rarely do patients develop nausea that is persistent and resistant to treatment. Some surgical procedures are more likely to cause nausea than others, such as gastric and abdominal surgeries. Also, combinations of anti-nausea medications can at times cause sedation and confusion. Therefore second and third line treatments for nausea are usually given in a stepwise fashion as needed. Together our nausea treatments are highly effective and you can approach your surgery with confidence that you will do well and, most likely, feel quite good.
For children having surgery, the goal is to have parents at the bedside as soon as their child comes out of the operating room. (Please See Pediatric FAQ’s for more information.)
The incidence of addiction to pain medicines after surgery is exceedingly rare. The occurrence is so rare that current medical recommendations state that addiction need not be a significant concern in treating acute post operative pain. Good pain control is actually a necessary and important part of the healing process. It is important to note that addiction or psychological dependence is separate from what is called tolerance or physical dependence. The body can develop tolerance and dependence after prolonged use of opioids and may require higher doses of narcotics to achieve the same effect. Also, with physical dependence there may be withdrawal symptoms when narcotics are discontinued. Fortunately, in the hospital and post operative setting these conditions are very rare. They are different from addiction, that is even less likely. You can have confidence that achieving good post operative pain control is a safe part of your overall recovery.
Your risk for blood clots can be further diminished by understanding risk factors and following the advice of your physicians before and after surgery. Smoking is a significant risk factor for multiple post operative problems including DVT. Obesity, estrogen (sometimes related to oral contraceptives), prior DVTs, some medical conditions and post operative immobility are all risk factors for blood clots. It is recommended that you discuss risk modification with your doctor before surgery.
After surgery, you can promote blood flow and reduce your risk of blood clots by doing prescribed exercises and walking with assistance, as recommended by your doctor, as soon as possible.
After your procedure, there will be bills from your surgeon, the hospital and the anesthesiologist. Just like the surgeon and hospital, the anesthesiologist has a fee. Revenues in Anesthesiology come almost entirely from these case-related charges. The fees are generated by consideration of the severity of your medical condition, the risk of the surgery, the type of anesthesia, related peri-operative procedures, and the duration of the anesthetic care.
Our department participates in most insurance plans and we continue to work toward in-network participation with all insurance carriers. We participate with Medicare and Medicaid. Participation in private insurance plans requires periodic contract negotiations that at times results in movement to out-of-network status. In recent years, it has been unfortunately common for insurance companies to break their contractual obligations to physicians and withhold payments without justification. Responding to this practice has required extra cost and administrative effort by doctors offices and we continue work toward fair and lawful conduct by insurance carriers.
Additionally, insurance coverage for patients continues to change. We understand and are aware of the burden this may place on some patients. Now, most patients will have a deductible and copay for their medical services. Therefore, the amount of the bill for which you are responsible as a patient is variable. In some cases you may be required to intervene with your insurance company to ensure that they cover all the charges they should. Our billers may be able to assist you in this process. If you have an outstanding balance after your insurance payment you may be responsible for that amount. In the case of financial hardship or other extenuating circumstances, you must contact our billing service to address the issue. Regardless of the situation, if you have questions about your bill, please contact our billing service for assistance. Please see our Insurance and Billing page.
Labor & Delivery FAQ
Please also see: “What to Expect During Surgery”
Another potential side effect from spinals and epidurals is headache. There are several potential causes of headache after delivery, most of which are not related to neuraxial injections. The kind of headache related to these techniques is called a Post Dural Puncture Headache (PDPH), commonly referred to as spinal headache. These headaches are infrequent, develop in the first few days after delivery, and can occur as a normal side effect of neuraxial injections. Occasionally, epidural placement will indicate the need to watch for headache. Spinal headaches also occur unexpectedly. They can resolve spontaneously but often require another lumbar injection to treat. Treatments for spinal headache are very effective. Our anesthesiologists are skilled and experienced in the care of laboring patients and the placement of neuraxial anesthetics including labor epidurals. While the true incidence of PDPH nationwide is difficult to estimate, the rate of occurrence in our institution has been far less that available averages.