The Good, the Bad and the Inevitable: Post-Surgical Complications in Pet Medicine
Published on August 02, 2013
There’s only one reasonable explanation for why a veterinarian’s patients might not suffer post-surgical complications: That doctor doesn’t perform surgery.
Complications are inevitable, after all, even when no one is at fault. That’s why they’re called “complications” and not “god-awful mistakes that could have been avoided with better training and closer attention to detail.”
In fact, post-surgical complications aren’t just inevitable. They’re pretty common, too. That’s why many major medical institutions (including plenty of vet schools) offer “Morbidity and Mortality” rounds (aka “M & M” rounds), a regular roundup of cases-gone-wrong. Because knowing how things go south is one way doctors learn.
Which might explain why we veterinarians are so practiced in the art of the post-surgical complication. Indeed, the complication rate that attends our patients’ recovery after any given procedure means we have ample opportunity to witness the many ways in which our work can be compromised.
The Drawbacks of a Quick Recovery
It makes sense. After all, pets aren’t likely to slow down after surgery — not unless we make them. Then there’s their mouthy way with a wound to consider. (No, licking a wound for hours on end is not healthy.) Given all their diabolically willful tricks, is it any wonder dogs and cats tend to bless their vets with plenty of post-op complication-based learning opportunities?
I’ve seen patients get around their E-collars and their T-shirts in desperate (and athletic) attempts to consume their stitches. I’ve seen dogs bounce around their crates until their wounds reopened from the strains of this simple (if relentless) activity. I’ve had mama cats somehow find their way back to their kittens to nurse post-sterilization (a surefire recipe for premature suture removal). And get this: A colleague once awoke to a midnight emergency call after a dog not only gnawed her incision open, but also consumed several lengths of her own intestines (apparently by way of keeping her spay incision “clean”).
Sometimes it even happens for no apparent reason. (“I promise she didn’t lick at it.”) Our animals are just like that. If they followed veterinary advice to take it easy, complication madness might not happen with such maddening regularity. But then, try telling that to the 6-month-old Lab who’s as likely to bowl you over as look at you.
Which has its pluses, of course. We should all be so lucky to exit the hospital feeling so well. It’s thanks to our modern anesthetic protocols and sophisticated pain-relieving abilities that our pets no longer slump in the corner and sleep it off for a couple of days. Instead, most are up and wagging their tails, bouncing off the walls, doing all the things pets should do — that is, if they hadn’t just spent the previous day in the OR getting their [fill-in-the-blank] removed.
Some Complications Can't Be Anticipated
Not that any of this makes you feel any better when it’s your pet who’s suffering a complication. Nor is every complication necessarily linked to your pet’s healthy exuberance or surfeit of post-surgical comfort. Sometimes complications arise from just plain bad luck.
Consider these common post-surgical complications:
- Adverse suture reactions beneath the skin that lead to rejected suture material exiting an incision site for months after a surgery
- Post-op pain-drug intolerances that yield vomiting
- Post-op antibiotics that cause diarrhea
- A cough that lingers for upwards of a week as the result of irritation from the endotracheal tube
- Transient stiffness or lameness from having to stay in one position for an extended period of time during surgery
Surgical Skill and Good Intentions Aren't Always Enough
Then there’s last week’s patient’s case:
Sparky had needed multiple dental extractions, and his owner had readily acquiesced to the procedure. As a physician, she’d understood the risks of anesthesia and infection well. But she’d not been prepared for the possibility of a complication arising from the nerve block, an injection administered to prevent the pain related to the extraction procedure itself.
So it was that when we discussed Sparky’s complication — bleeding around the whites of his eye as a result of my nicking a nearby vessel during the injection — she seemed a bit put out over the whole thing. Which only made sense. I’d have been alarmed, too. I mean, a bloody eye looks as terrible as it sounds. Luckily, however, it doesn’t hurt, vision isn’t impaired and it always resolves quickly.
“What can I say?” I offered after I’d explained the complication and the difficulty of skirting vessels when you’re trying to block nerves (they live nearby one another). “I’m so sorry! But look at it this way: If I didn’t block a nerve with an injection, he wouldn’t be as comfortable as he is right now. Small price to pay, right?” To which she readily agreed, mollified also, no doubt, by my phone number and plenty of assurances that things would resolve quickly.
Which brings me to my final point: Complications in pet medicine may be inevitable, but resolving them satisfactorily between humans is not. That’s the hard part. And, unfortunately, that’s nothing any veterinarian or physician learns during M & M rounds. That’s a skill we have to practice personally if we plan on keeping our clients’ trust.