Consumer Guide to Elective Surgery and Procedures
Thank you for recognizing your pet may need to undergo an elective procedure such as spay or neutering. Many people “shop around” for the best price on this surgery, without the knowledge of why the cost varies among veterinary practices. Some places feel much pressure to lower their surgical fees to remain competitive and attract clients . Unfortunately, in some cases this may compel hospitals to cut corners on their standard of care to reduce their costs. This guide was put together to help you find the best fit between the veterinary practice and your expectations for the care of your pet. I recommend you ask for the details and a hospital tour before booking elective surgery and procedures for your pet.
1. What pre-anesthesia evaluation will my pet have prior to surgery?
This is important for a number of reasons. A physical examination is our first defense against performing surgery on an animal that may have an infectious disease, a heart murmur, or be debilitated from parasites. A pre-anesthesia blood test can detect hidden problems that could cause serious complications when the pet is under anesthesia or in surgery.
2. What safety precautions will be taken with my pet during surgery?
While most surgery is uneventful, emergencies sometimes arise. Early detection of impending problems greatly aids our ability to intervene and correct the problem. An IV catheter will be placed prior to anesthesia induction. The IV catheter is our port for providing emergency drugs if there is an emergency. Having a catheter preplaced is one of the most important procedures for safety. IV fluids will be administered to help maintain blood pressure, provide internal organ support and to help keep your pet from becoming dehydrated. The most common anaesthetic complication is low blood pressure. If an IV catheter is not pre-placed prior to starting anaesthesia, a low blood pressure event can cause the collapse of peripheral veins making attempts to then place an IV catheter very challenging or impossible. Using an IV pump to ensure accurate, safe administration of IV fluids is an important, yet increased cost.
A breathing tube should be placed (intubation) on all anesthetized animals. This keeps the airway open and allows for supplemental oxygen or gas anesthesia as needed. This tube is also very important to prevent aspiration into the lungs if a pet vomits or otherwise has excess fluids/materials in its mouth. If there is an aspiration, this causes a serious pneumonia.
A respiratory monitor and heart monitor allows the surgical team to keep track of heart rate and rhythm as well as the amount of oxygen in the blood. And a blood pressure monitor allows for early detection of blood pressure fluxuations and rapid treatment.
3. What safety precautions and comfort measures will be taken?
Anesthesia and surgery patients lose body heat through anesthesia and the opening of body cavities. Warmth should be provided during and after anesthesia. When a patient gets cold they become uncomfortable and the heart can be affected. Patient temperature should be monitored at regular intervals after surgery and supplemental heating provided as needed. Ideally, surgical table warmers help patients to maintain their body temperature during surgery. Your pet’s gum color, pulse, and respiration should also be monitored.
4. How will pain be controlled for my pet?
This is very important – surgery hurts! The anesthetic will not provide pain control once the pet wakes up. Pain should be controlled before, during and after the day of surgery. The argument that “pain is good” to prevent animals from being over-active during healing is misguided and results in pets suffering pain needlessly.
5. Will I receive written post-surgical care instructions for my pet?
Aftercare of surgical patients is very important for proper healing. The hospital should provide written discharge instructions for your pet. There is much to know, too much to remember, and other family members not present at discharge may want to familiarize themselves with post-operative care instructions.
6. In what ways can the services be compromised to lower competitors prices?
There are so many ways that corners can be cut. Although your pet may survive the procedure, greater risks maybe taken. These risks are known to increase the chance of infection, pain, suffering and death. Since there are few laws that regulate these issues in Ontario, some veterinary hospitals cut corners to be able to offer the lowest price possible. We firmly believe that the clinics that cut corners are not adequately informing their clients of the risks involved. We believe owners should have choices and should not be disrespected if they cannot afford uncompromising care, but feel all pet owners should be informed that the lowest price probably means the lowest service. We have researched all the issues to develop our protocols. We believe our patients deserve uncompromising care. The following is a list of the ways we provide uncompromised care.
The patient should be prepared for surgery in a preparation area, not in the surgery room. This prevents hair and debris from possibly contaminating the surgery area.
It is expensive to have an area where only sterile surgeries are performed. So, if the surgery area is not a single use area infection rates are increased by increased traffic within the room. Performing surgeries or procedures that are not sterile surgeries, such as dental procedures, in the surgical suite increases infection rates. Poorly maintained flooring, ceilings and or walls in the surgery room increases the infection rate as these can harbor debris, bacteria and viruses.
Preparation of the patient
The patient should be examined and have a pre-anesthesia screen. In most young healthy pets, this is a simple blood test. In pets that are a little older or have other issues discovered, a urinalysis or other tests might be recommended.
Once the pet is in the hospital on the morning of the procedure, medications should be used to relax the patient and start the pain management program. Again, forgoing this step leads to a much more nervous pet, which increases the release of epinephrine in the system and can actually lead to increased abnormal heart contractions. Of course, it is cheaper to delete this step.
As noted above, not placing an IV catheter, not starting IV fluids, no intubation, not monitoring for respiration and heart rate and rhythm all reduces the cost of the procedure but increases your pet’s risk.
Surgical instruments and supplies
Instruments used should be of high quality and well cared for. Using less than high quality instruments can lead to increased tissue trauma and increased pain and a longer healing time. The surgical pack of instruments should be used on only one pet, then cleaned, lubricated, repackaged and sterilized. Using instruments on more than one animal between cleanings and sterilization can lead to an increased chance of infection and infectious disease.
Surgical gloves are made to be disposed of after each surgery. In some hospitals, gloves are reused. The chance of microscopic holes in them drastically increases, leading to increased rates of infections and complications. Of course that is still better than in the places that are not using gloves at all, or are using non-sterile examination gloves for surgery.
The choice of suture material varies greatly. Suture selection involves determining what material to use. Some materials are not very strong, and cause increased inflammation within the tissues or the knots can even untie. These materials are very inexpensive. Better products have less reaction, with less pain and tissue trauma/inflammation caused, allowing faster healing and greater security. Better products cost more and add to the cost of the surgery. Some hospitals “reuse” suture material from one surgery, after it has been dragged through tissue, placed in cold sterile solution and then used again in a subsequent surgery. It should go without saying that this protocol provides substandard, weakened, dulled, high infection potential suture material to patients to save money.
Providing the safest possible surgical experience requires a team of skilled individuals. A compassionate, skilled, experienced surgeon is ideal. While they are performing surgery your pet’s anaesthesia requires vigilant monitoring. There are insufficient anaesthetists to staff general practices, so the education, training and certification of a Registered Veterinary Technician (RVT) includes fulfilling the skilled roll of anesthetist. An RVT can expertly assess the effects of anaesthesia, detect and respond to abnormalities, and provide emergency treatment. They are also experts are detecting the subtle indication of a pet experiencing pain. Employing RVTs can be costly for a clinic but their presence during your pet’s anaesthesia is invaluable and should not be replaced by an “assistant” or receptionist.
The recovery phase of an anaesthesia is very important. As the breathing tube is removed close monitoring is important to ensure continued unobstructed breathing. As the anaesthetic wears off we need to be ever vigilant but signs of discomfort, nausea, disorientation, pain and cold. Typically at this time the surgeon is back into their next surgery; having sufficient skilled staff (RVTs) to provide close monitoring of both current surgeries and pets in their recovery stages should not be compromised. Often this is where “High volume Spay-Neuter Clinics” may fail. They are processing so many surgeries in a short amount of time, they rarely have sufficient RVTs to provide one-on-one monitoring during both anaesthesia and recovery stages.
Our pets cannot hit the “call button” to tell us what they need. So we are charged with the responsibility of providing for all their needs without being asked. So we provide multi-level pain control (pre-operative, intra-operative and post-operative), we use a combination of anti-inflammatory and narcotic pain medications to ensure our patient’s comfort. Have you ever slept on a hard floor, or just been offered a thin, thread-bare towel for comfort? Ensuring our patients have comfortable bedding protects them from injury, helps keep them warm, and allows them a comfortable sleep. IV fluids are crucial during anaesthesia but will make patients have to urinate afterwards, ensuring that cats always access to a litter box and dogs given an opportunity to relieve themselves outside once they feel up to walking, helps ensure they are comfortable during hospitalization. Many studies have shown that anaesthesia can temporarily halt digestive function and the sooner a patient has a meal post-anaesthesia then the digestive disruptions can be minimized. Offering patients a small meal within a few hours of waking is important.
It may surprise you to hear that these cost cutting choices still occur at some places, and so it should. If you are lucky this will be the only surgery your pet ever needs so getting it right is important. Never be shy to ask some of these tough questions of your potential service provider – your pet will thank you! Good service providers will welcome the opportunity to answer your questions. We understand that cost is important because surgery is expensive, and we do our utmost to make it as affordable as possible for you without compromising our standard of care. One final note – ask about extra fees!
*Does the cost of surgery include a pre-op exam for a new patient, or is that extra?
*Are you required to have your pet vaccinated prior to surgery? If yes, that may increase your costs.
*Are Intravenous fluids included, or is it an extra fee?
*Is a Pre-anaesthetic blood screen included, or is it extra?
*Is pain medication dispensed home included, or is it extra?
*If you don’t have a “No-Bite” or “Elizabethan collar” at home to prevent your pet licking at their incision, you may need one – what will that cost?
*If your pet needs to be examined by the veterinarian during healing, do you pay extra for that?
After asking these questions you may find that what appears to be the same service for less cost, actually adds up to the same cost, or more, then the next place.