Our Summary

Every year, around 310 million major surgeries are performed worldwide, with 40 to 50 million in the US and 20 million in Europe. Unfortunately, 1-4% of these patients will die, 15% will face serious health problems after surgery, and 5-15% will return to the hospital within 30 days. This means around 8 million people die globally each year from surgery, similar to the number of deaths caused by heart disease, stroke, cancer, or injuries. If we thought of surgical complications as a global health crisis, like HIV/AIDS or COVID-19, we would be working together to create a plan, and put resources towards addressing it. This could help save lives and billions of dollars in healthcare costs.

Part of the issue is that hospitals in rich and poor countries do things differently. There’s also a lack of effective drugs to protect patients from the stress of surgery. Even though a patient is asleep due to anesthesia during surgery, their brain is still “awake” and reacting to the stress of the procedure. This can lead to the brain causing a series of harmful reactions in the body, like increased inflammation, blood clotting, immune system activation, and metabolic dysfunction.

The authors suggest that new injection drugs are needed right after anesthesia and before the first cut in surgery. These could prevent the brain from causing these harmful reactions. They also propose a systems-based approach focused on the connection between the brain and mitochondria (the powerhouse of cells). This type of research may help improve the results after major surgeries, both for regular patients and those in the military.

FAQs

  1. How many major surgeries are performed globally each year and what is the associated mortality rate?
  2. What are the common postoperative complications and how often do they occur?
  3. What is the significance of the anesthetized brain being ‘awake’ during surgery and how does this impact post-surgical complications?

Doctor’s Tip

One helpful tip a doctor might tell a patient about brain surgery is to follow all pre-operative instructions carefully, including fasting before the surgery and avoiding certain medications. It is important to discuss any concerns or questions with your healthcare team before the procedure. Additionally, following post-operative instructions for recovery and rehabilitation is crucial for a successful outcome. It is also important to attend all follow-up appointments and communicate any changes or concerns with your healthcare provider.

Suitable For

Patients who are typically recommended for brain surgery include those with conditions such as brain tumors, aneurysms, epilepsy, traumatic brain injuries, and certain neurological disorders. These conditions may require surgical intervention to remove tumors, repair blood vessels, control seizures, or relieve pressure on the brain. Additionally, patients with certain types of brain tumors or lesions that are causing significant symptoms or impairing brain function may also be candidates for surgery. It is important for patients to consult with a neurosurgeon to determine the best course of treatment for their specific condition.

Timeline

Before Brain Surgery:

  1. Patient undergoes preoperative evaluation and testing to determine the need for surgery.
  2. Patient meets with surgeon and medical team to discuss risks, benefits, and expectations of the surgery.
  3. Patient may undergo additional imaging studies to further assess the brain condition.
  4. Patient may need to follow specific preoperative instructions such as fasting before surgery.
  5. Patient may be prescribed medications to help prepare for surgery.

After Brain Surgery:

  1. Patient is closely monitored in the recovery room for any immediate complications.
  2. Patient may be transferred to the intensive care unit for further monitoring and management.
  3. Patient may experience pain, swelling, and discomfort at the surgical site.
  4. Patient will be prescribed medications for pain management and to prevent infection.
  5. Patient will undergo regular follow-up appointments and imaging studies to monitor recovery and assess the success of the surgery.
  6. Patient may be referred to rehabilitation services for physical and cognitive therapy to aid in recovery and regain function.
  7. Patient and caregivers will receive education on postoperative care and signs of complications to watch for.

What to Ask Your Doctor

  1. What specific type of brain surgery is being recommended for me and why?

  2. What are the potential risks and complications associated with this type of brain surgery?

  3. How experienced is the surgical team in performing this type of brain surgery?

  4. What is the expected recovery time and rehabilitation process after the surgery?

  5. Are there any alternative treatment options to consider before proceeding with brain surgery?

  6. How will my pain be managed during and after the surgery?

  7. What is the success rate for this type of brain surgery in patients with conditions similar to mine?

  8. What follow-up care will be needed after the surgery and what signs of complications should I watch out for?

  9. How long will I need to stay in the hospital after the surgery?

  10. Are there any lifestyle changes or restrictions I should be aware of after the surgery?

Reference

Authors: Dobson GP. Journal: Int J Surg. 2020 Sep;81:47-54. doi: 10.1016/j.ijsu.2020.07.017. Epub 2020 Jul 29. PMID: 32738546