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December 20, 2013

CNN: When simple surgeries go wrong

Daily Briefing

A routine tonsillectomy that left a 13-year-old girl brain dead and on life support has sparked a national debate about the risks of the simplest medical procedures, CNN's Jacque Wilson reports.

Details about a tonsillectomy gone wrong

On Dec. 9, 13-year-old Jahi McMath underwent routine surgery to have her tonsils removed at a pediatric hospital in Oakland, Calif. Doctors had recommended the surgery to treat McMath's sleep apnea, weight gain, inability to concentrate, uncontrolled urination, and short attention span.

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Shortly after waking from her surgery, McMath began bleeding from her nose and mouth and went into cardiac arrest. Medical staff performed chest compressions and administered clotting medications, but a CT scan later revealed two-thirds of McMath's brain had swelled, leaving her brain dead. The family is currently fighting to keep her on life support.  

"The big question is, 'How in the world did this happen?'" asked CNN medical correspondent Elizabeth Cohen, adding, "You're talking about a tonsillectomy, right?"

Experts: No 'routine' surgery is 100% safe

Tonsillectomy is the third most common surgical procedure performed on children in the country, after circumcision and ear tubes, according to the American Academy of Otolaryngology. Among adults, routine surgeries include appendectomy, cholecystectomy, and cesarean section.

However, experts say that just because these procedures are common doesn't mean they are 100% safe. While a surgery may have been performed thousands of times by a particular surgeon, each patient presents their own risks and potential for post-surgery complications.

Albeit rare, "uncontrollable bleeding can happen in almost any surgery," says Albert Wu, director of Johns Hopkins' Center for Health Services and Outcomes Research, adding that in "extreme cases, you can bleed out." Other post-surgery complications can include infection and damage to nearby tissue, he notes.

  • In a study of more than 14,000 patients undergoing surgery to get either their tonsils or adenoids removed, bleeding occurred in about 3% of the patients, with five patients requiring a blood transfusion.
  • Another study of more than 33,000 tonsillectomy patients found that about 1.3% of patients were kept at the hospital longer than expected or were required to return within 28 days. Eight patients needed a blood transfusion, and one study participant died.

For other common surgeries, the rate of complications is somewhat higher, CNN notes. A study of 1,254 laparoscopic cholecystectomies found complications in 12% of patients. However, the risk of death remains relatively low: A 1996 meta-analysis found the death rate for gallbladder removal ranges from .086% to .74%.

Wu notes that some patients are at a higher risk for adverse events than others. For instance, patients with pre-existing heart, lung, or liver conditions are more likely to suffer from complications or die. Obese patients are also at higher risk.

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Wu's advice to patients: Ask yourself, 'Do I need surgery?'

Before undergoing surgery, Wu recommends that patients tell their doctors "everything that they know about themselves," including their past experiences with surgery and anesthesia, whether they have any allergies, and whether they're prone to bruising or heavy bleeding.

Additionally, he urges patients to ask themselves, "Do I need this surgery?" In certain situations, not undergoing surgery may be "riskier than having the surgery," Wu says, adding "but for many, many things, the surgery is quite discretionary. You have a choice" (Watkins/ Cuevas, CNN, 12/18; Wilson, CNN, 12/19).

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