From the Agency for Health Care Policy and Research
Are you facing surgery? You are not
alone. Millions of Americans have surgery each year. Most operations are
not emergencies. This means you have time to ask your surgeon questions
about the operation and time to decide whether to have it, and if so,
when and where. The information presented here does not apply to
The most important questions to ask about elective surgery are why the
procedure is necessary for you and what alternatives there are to
surgery. If you do not need to have the operation, then you can avoid
any risks that might result. All surgeries and alternative treatments
have risks and benefits. They are only worth doing if the benefits are
greater than the risks.�
Your primary care doctor, that is, your regular doctor, may be the one
who suggests that you have surgery and may recommend a surgeon. You may
want to identify another independent surgeon to get a second opinion.
Check to see if your health insurance will pay for the operation and the
second opinion. If you are eligible for Medicare, it will pay for a
second opinion. You should discuss your insurance questions with your
health insurance company or your employee benefits office.
Following are 12 questions to ask your primary care doctor and surgeon
before you have surgery, and the reasons for asking them. The answers to
these questions will help you be informed and help you make the best
decision. Sources are listed at the end of these questions to help you
get more information from other places.
Your doctors should welcome questions. If you do not understand the
answers, ask the doctors to explain them clearly. Patients who are well
informed about their treatment tend to be more satisfied with the
outcome or results of their treatment.
1. What operation are you recommending?
Ask your surgeon to explain the surgical procedure. For example, if
something is going to be repaired or removed, find out why it is
necessary to do so. Your surgeon can draw a picture or a diagram and
explain to you the steps involved in the procedure.
Are there different ways of doing the operation? One way may require
more extensive surgery than another. Ask why your surgeon wants to do
the operation one way over another.
2. Why do I need the operation?�
There are many reasons to have surgery. Some operations can relieve or
prevent pain. Others can reduce a symptom of a problem or improve some
body function. Some surgeries are performed to diagnose a problem.
Surgery also can save your life. Your surgeon will tell you the purpose
of the procedure. Make sure you understand how the proposed operation
fits in with the diagnosis of your medical condition.
3. Are there alternatives to surgery?
Sometimes, surgery is not the only answer to a medical problem.
Medicines or other nonsurgical treatments, such as a change in diet or
special exercises, might help you just as well or more. Ask your surgeon
or primary care doctor about the benefits and risks of these other
choices. You need to know as much as possible about these benefits and
risks to make the best decision.
One alternative may be “watchful waiting,” in which your
doctor and you check to see if your problem gets better or worse. If it
gets worse, you may need surgery right away. If it gets better, you may
be able to postpone surgery, perhaps indefinitely.
4. What are the benefits of having the operation?
Ask your surgeon what you will gain by having the operation. For
example, a hip replacement may mean that you can walk again with ease.�
Ask how long the benefits are likely to last. For some procedures, it is
not unusual for the benefits to last for a short time only. There might
be a need for a second operation at a later date. For other procedures,
the benefits may last a lifetime.
When finding out about the benefits of the operation, be realistic.
Sometimes patients expect too much and are disappointed with the
outcome, or results. Ask your doctor if there is any published
information about the outcomes of the procedure.
5. What are the risks of having the operation?
All operations carry some risk. This is why you need to weigh the
benefits of the operation against the risks of complications or side
Complications can occur around the time of the operation. Complications
are unplanned events, such as infection, too much bleeding, reaction to
anesthesia, or accidental injury. Some people have an increased risk of
complications because of other medical conditions.
In addition, there may be side effects after the operation. For the most
part, side effects can be anticipated. For example, your surgeon knows
that there will be swelling and some soreness at the site of the
Ask your surgeon about the possible complications and side effects of
the operation. There is almost always some pain with surgery. Ask how
much there will be and what the doctors and nurses will do to reduce the
pain. Controlling the pain will help you be more comfortable while you
heal, get well faster, and improve the results of your operation.
6. What if I don’t have this operation?
Based on what you learn about the benefits and risks of the operation,
you might decide not to have it. Ask your surgeon what you will
gainor loseby not having the operation now. Could you be in more
pain? Could your condition get worse? Could the problem go away?
7. Where can I get a second opinion?
Getting a second opinion from another doctor is a very good way to make
sure having the operation is the best alternative for you. Many health
insurance plans require patients to get a second opinion before they
have certain non-emergency operations. If your plan does not require a
second opinion, you may still ask to have one. Check with your insurance
company to see if it will pay for a second opinion. If you get one, make
sure to get your records from the first doctor so that the second one
does not have to repeat tests.�
8. What has been your experience in doing the operation?
One way to reduce the risks of surgery is to choose a surgeon who has
been thoroughly trained to do the procedure and has plenty of experience
doing it. You can ask your surgeon about his or her recent record of
successes and complications with this procedure. If it is more
comfortable for you, you can discuss the topic of surgeons’
qualifications with your regular or primary care doctor.
9. Where will the operation be done?
Most surgeons practice at one or two local hospitals. Find out where
your operation will be performed. Have many of the operations you are
thinking about having been done in this hospital? Some operations have
higher success rates if they are done in hospitals that do many of those
procedures. Ask your doctor about the success rate at this hospital. If
the hospital has a low success rate for the operation in question, you
should ask to have it at another hospital.
Until recently, most surgery was performed on an inpatient basis and
patients stayed in the hospital for one or more days. Today, a lot of
surgery is done on an outpatient basis in a doctor’s office, a special
surgical center, or a day surgery unit of a hospital. Outpatient surgery
is less expensive because you do not have to pay for staying in a
Ask whether your operation will be done in the hospital or in an
outpatient setting. If your doctor recommends inpatient surgery for a
procedure that is usually done as outpatient surgery, or just the
opposite, recommends outpatient surgery that is usually done as
inpatient surgery, ask why. You want to be in the right place for your
10. What kind of anesthesia will I need?
Anesthesia is used so that surgery can be performed without unnecessary
pain. Your surgeon can tell you whether the operation calls for local,
regional, or general anesthesia, and why this form of anesthesia is
recommended for your procedure.
Local anesthesia numbs only a part of your body for a short period of
time, for example, a tooth and the surrounding gum. Not all procedures
done with local anesthesia are painless.�
Regional anesthesia numbs a larger portion of your body, for example,
the lower part of your body for a few hours. In most cases, you will be
awake with regional anesthesia.�
General anesthesia numbs your entire body for the entire time of the
surgery. You will be unconscious if you have general anesthesia.
Anesthesia is quite safe for most patients and is usually administered
by a specialized physician (anesthesiologist) or nurse anesthetist. Both
are highly skilled and have been specially trained to give anesthesia.�
If you decide to have an operation, ask to meet with the person who will
give you anesthesia. Find out what his or her qualifications are. Ask
what the side effects and risks of having anesthesia are in your case.
Be sure to tell him or her what medical problems you have including
allergies and any medications you have been taking, since they may
affect your response to the anesthesia.�
11. How long will it take me to recover?
Your surgeon can tell you how you might feel and what you will be able
to do or not do the first few days, weeks, or months after surgery. Ask
how long you will be in the hospital. Find out what kind of supplies,
equipment, and any other help you will need when you go home. Knowing
what to expect can help you cope better with recovery.
Ask when you can start regular exercise again and go back to work. You
do not want to do anything that will slow down the recovery process.
Lifting a 10-pound bag of potatoes may not seem to be “too
much” a week after your operation, but it could be. You should
follow your surgeon’s advice to make sure you recover fully as soon as
12. How much will the operation cost?
Health insurance coverage for surgery can vary, and there may be some
costs you will have to pay. Before you have the operation, call your
insurance company to find out how much of these costs it will pay and
how much you will have to pay yourself.
Ask what your surgeon’s fee is and what it covers. Surgical fees often
also include several visits after the operation. You also will be billed
by the hospital for inpatient or outpatient care and by the
anesthesiologist and others providing care related to your operation.�
You will want to know that your surgeon is experienced and qualified to
perform the operation. Many surgeons have taken special training and
passed exams given by a national board of surgeons. Ask if your surgeon
is “board certified” in surgery. Some surgeons also have the
letters F.A.C.S. after their name. This means they are Fellows of the
American College of Surgeons and have passed another review by surgeons
of their surgical practices.