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.  What is sad is that some places charge a lot, but still cut so many corners.  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 preanesthesia 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 infectious disease, a heart murmur, or be debilitated from parasites.  A preanesthesia blood test can detect for 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.  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 (EKG) monitor allows the surgeon to keep track of heart rate and rhythm as well as the amount of oxygen in the blood.  The practice should also have a "crash box" handy, which contains emergency drugs and supplies.

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. If patients get cold the pet becomes uncomfortable and the heart can be affected.  Patient temperature should be monitored at regular intervals after surgery and supplemental heating provided as needed.  Your pet's gum color, pulse, and respiration should also be monitored. The iv fluids can be warmed to body temperature as well as patients given adequate coverage to reduce heat loss.

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.

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.

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 no laws that regulate these issues in Washington State, 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 facility

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 in the surgical suite increases infection rates.  Having a sink in the same room as the surgery is completed increases infection rates.  Carpeting or 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 preanesthesia 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 might be recommended.  Chest radiographs or other evaluations may be recommended or required.  To reduce the cost of procedures, these screening tests may be completely omitted.  Abnormalities may then not be detected until it is too late, or may make recovery after the surgery much harder on the pet and the owner.

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 at your pets risk.

The patient should be clipped, vacuumed free of debris and special disinfectants used to prepare the surgical area prior to being moved into the surgical suite.

Surgical preparation and attire of surgeon and assistants

Surgeons and assistants should prepare themselves to prevent contamination by wearing a surgical cap and mask.  They should scrub their hands three times before donning a sterile surgical gown and gloves.  It is somewhat ironic that food workers are required to wear a cap or somehow control their hair, but veterinary surgeons are not.

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 autoclaving can lead to 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 nonsterile exam' gloves for surgery.

The choice of suture material varies greatly.  The differences may not be readily apparent to pet owners that cannot compare differences, but those who have studied and tested the choices have published that there are differences on both gross and microscopic levels.  Some places reuse suture materials not used up from a prior surgery.  These materials have been dragged through the tissues of the prior animal and may be placed in a cold sterile' solution until used again.  Obviously, infection rates can be increased as well as tissue trauma.  Suture materials may even weaken from such practices.  Another cost cutting method is to use suture off a reel.  This is an inexpensive way to purchase suture materials.  These sutures are then rolled off the reel and threaded through a needle (which may have been used on multiple pets in the past and be dull).  The longer the reel has been in use, the greater the chance of contamination, all this leading to higher infection rates.  Additionally, the suture that is threaded through the needle leaves a much larger hole in the tissue it penetrates.  This increases tissue trauma, pain and healing time.  

The alternative is to use suture materials that are prepackaged for single use and have a swaged on needle.  The suture material is one piece with the needle and is inserted into the rear end of the needle.  This allows for very tiny, nontraumatic punctures that produce less pain and tissue trauma.  Since the needles are then used only for that, the needles stay sharp, again leading to decreased pain and tissue trauma.

Suture selection also 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.

The surgery performed

Most surgeries for spays and neuters are performed swiftly and with skill at most hospitals.  We have mentioned many things that can change how the patient is after the surgery even if the typical owner cannot appreciate the difference.  The above-mentioned cost cutting choices have in the past and may still occur at some places.  In addition to not cutting corners we close the surgical site with hidden' or buried suture patterns.  This means, that the pet does not have to return for suture removal saving you time.  We also do not need to give any prophylactic antibiotics to cover for sloppy service.  We have an open invitation for our pet owners to bring their pets by at no charge post surgery to check the surgery site, or for any post op complications due to our service.