Complications of Surgery That
They Don't Tell You About
By Dr. Kayla Frost (DPT, PT)
When you are suffering from an injury and are considering surgery, it is important to know all of your options. Surgery is a risky medical procedure that doesn’t always work. Physical therapy is a conservative way to treat injuries and chronic pain, and may serve as a better alternative. Unless it is a medical emergency and you need an operation right away, you should take the time to weigh all of the pros and cons, and question whether it is really indicated.
Your doctor should only recommend surgery if it is essential. However, for many patients, surgery is not the most desirable or necessary course of action. According to Marty Makary, MD, MPH, a surgeon at Johns Hopkins Medicine in Baltimore, and author of Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care, “some hospitals still provide bonuses for more volume. Doctors have an incentive for over-treatment.” This means that performing an operation on you may be in the hospital’s or doctor’s best interest, and not yours.
I have seen this before – you may feel scared and pressured to get surgery when your doctor tells you that your x-ray or MRI “looks bad.” However, medical imaging doesn’t tell the whole story of your condition. Often times, x-rays and MRIs are misleading. For example, if your pain is actually caused by muscular imbalances, this will not appear on an x-ray or MRI, and will definitely not be fixed with surgery alone. Sometimes the best way to pick up on the source of your pain is to analyze your movement with a physical therapy evaluation.
In general, most doctors do their best to minimize the risks of surgery. However, no surgery is without risk, so it is important that you are educated on those different risks and how to do your part to minimize your chances of complications.
Here are a few of the complications of surgery that nobody tells you about:
You may still have pain after surgery. The pain might be worse. It might last a long, long time.
Surgery isn’t always the quick fix that people are looking for. People who have surgery may be unprepared for the severity and impact of postoperative pain. That pain can rewire your nervous system in unpredictable ways. Complex regional pain syndrome (CRPS) is a rare, chronic pain disorder that sometimes occurs after surgery and can last for years.1
Insurance may limit your recovery.
Difficulties with insurance may prevent timely recovery. “Prior authorization,” “preauthorization,” or “precertification” is when your health insurance company reviews your situation and dictates the medical necessity of a treatment or medication. Complications with these processes frequently arise, making the preparation for surgery and recovery very stressful. I have seen it take unnecessarily long for patients to acquire the necessary medications or assistive equipment they need to help them perform activities of daily living (i.e. shower chair, crutches, walking boot, knee scooter, etc.). Delays with insurance due to slow communication between health care staff might also prevent you from receiving post-op needs or physical therapy in a timely manner. These setbacks may jeopardize your recovery and hold you back from returning to the things you love.
You may develop new limitations in your function.
In my clinical experience, I have encountered so many musculoskeletal side-effects of surgery. One of the things I see all of the time has to do with scar tissue accumulating over the incision site, weeks to years after surgery. I had a patient who underwent a right hip replacement because she was experiencing right hip pain from arthritis. Months after surgery, she still had pain in her hip from scar tissue buildup under the incision site, causing the muscles and fascia to adhere to the scar. Such restrictions prevent the muscle from sliding and gliding normally over other soft tissue, leading to inflammation, pain, and limitations in range of motion.
You might have swelling for months, maybe years afterwards.
I see this a lot with total knee replacements. People have pain and arthritis in their knee, so they get a knee replacement. Then, they have chronic swelling that lasts for months to years, and the littlest amount of exercise causes the knee to “blow up” with swelling. There is no knowing how your body will receive a new body part, and there is a chance that your body will reject it.
Short-term or long-term stomach problems.
Postoperative nausea and vomiting (PONV) is a common short-term side-effect of anesthesia. PONV may lead to prolonged hospital stays and more severe complications.2 Long-term gastrointestinal upset can also be a component of the sequela of surgery. Although non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, celecoxib, aspirin, and naproxen are generally considered safe to control symptoms of inflammation after surgery, they do have gastrointestinal side effects when taken frequently. NSAIDs have been linked to peptic ulcer disease.3 NSAIDs work by inhibiting the COX enzymes that play a role in inflammation and pain. However, many NSAIDS are non-selective, meaning they inhibit the COX-1 enzyme, which has a protective effect on the stomach. Be careful when treating yourself with over-the-counter medications because even these can cause undesirable long-term side-effects.
Hospitalization causes physical complications.
Being bed-ridden takes a huge toll on the body. For every day that goes by in the hospital, you will lose more and more muscle mass. In addition, by not moving like you’re used to, you will have a higher risk of getting blood clots that can cause stroke, pulmonary embolism, and heart attack. I had a patient who underwent back surgery last year. After the operation, he ended up getting a blood clot in his lung and having to undergo another complicated surgery to remove the clot and insert a vena cava filter. It was a miracle that he survived. His rehab ended up being way longer than anticipated because now we were rehabilitating his lungs, as well as his back, while also trying to control the swelling in his ankles from being put on blood thinners. Moral of the story: complications from surgery and hospitalization can be severe.
If you are going to get surgery, here are a couple of recommendations:
Get “prehab.”
- Prehab is a rehabilitation program you do before surgery. The purpose of prehab to get as strong as possible before surgery takes place. Sometimes, by participating in prehab, you gain enough strength that your condition resolves and you don’t need surgery.
- If you do need surgery, ask your doctor about prehab. Many conventional doctors don’t think to refer patients to physical therapy until after they’ve had surgery. By this time, muscles have become so deconditioned, it is difficult to get the strength back, and you might be putting yourself at more risk of further injury or disability. Ask your doctor if you can front-load your physical therapy to gain or maintain strength in important muscle groups before surgery.
Boost your immune system.
- Surgery is a traumatic event for the body. When you come out of surgery, your body works overtime to heal the surgical site, so you may be more at risk of getting sick. Surgery can also introduce foreign bacteria into your bloodstream. You will want to build up your immune system to fight all sorts of infections and help you bounce back faster.
Surgery is a turning point in many people’s lives. If you've struggled with chronic pain and injuries, first try physical therapy as a conservative treatment.
References:
Lloyd ECO, Dempsey B, Romero L. Complex Regional Pain Syndrome. Am Fam Physician. 2021;104(1):49-55.
Weibel S, Rücker G, Eberhart LH, et al. Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: a network meta-analysis. Cochrane Database Syst Rev. 2020;10(10):CD012859. Published 2020 Oct 19. doi:10.1002/14651858.CD012859.pub2
Shim YK, Kim N. Korean J Gastroenterol. 2016;67(6):300-312. doi:10.4166/kjg.2016.67.6.300