Any surgery has risks, even those we think of as routine. We often don’t think twice about scheduling some procedures for our children because they are so common they seem to be harmless; and, of course, the vast majority of us would never knowingly subject our children to harm. But even “routine” surgeries can have complications, as these recent news reports show.
A 13-year-old girl in California was declared brain dead three days after undergoing a routine tonsil removal surgery in December 2013. The child’s physician recommended the surgery because she suffered from sleep apnea. During the patient’s recovery, she experienced excessive bleeding and trouble breathing, went into cardiac arrest and was declared brain dead. Whether or not she will remain on life support is a continuing issue before the courts.
Tonsillectomy is the most common surgical procedure in children. More than half a million tonsillectomies are performed in the United States each year. According to The Journal of Family Practice, mortality rates for the operation range from 1 in 10,000 to 1 in 35,000. The most common complication is postoperative bleeding, which usually occurs within the first 24 hours after surgery. About 1 in 200 patients is returned to the OR so that bleeding can be controlled. Other complications can include pain, nausea and vomiting. Many tonsillectomies are performed on an outpatient basis, but the Journal recommends that patients with sleep apnea, coagulation disorders, or other underlying diseases, and anyone younger than 4 years of age or living a long distance from the hospital should be admitted for overnight observation.
Earlier this year, in February, another teenaged patient died after a routine tonsillectomy at a surgical center. After the surgery, she was given Fentanyl, a strong narcotic pain reliever known to depress respiration. Her failing respiratory condition went unnoticed and she sustained significant brain damage due to oxygen deprivation. She died 15 days later. The family filed a medical malpractice case against the surgical center and received $6 million in settlement.
Another common surgical procedure for children and young adults is the removal of wisdom teeth. In March of 2013, a 24-year-old California man died unexpectedly after undergoing this routine oral procedure in a doctor’s office. A former football player, he had no known health problems. During the procedure, the patient woke up coughing, so he was given more anesthesia. (The medical records later showed he received five kinds of sedative medications, including propofol.) He went into cardiac arrest. Responding EMTs took him to a hospital, where he died three days later.
Another death from the administration of propofol during wisdom tooth surgery occurred in 2011, when a 13-year-old girl from Ohio died of brain damage. She never awoke from the sedation given in the doctor’s office. The girl was taken to a hospital, where she died two weeks later. The parents won a $1 million settlement in a personal injury lawsuit.
In April 2012, a 17-year-old Maryland girl went to her doctor for removal of her wisdom teeth. Just 15 minutes after the procedure began, she experienced respiratory complications. Her brain was severely damaged and she died 10 days later. The oral surgeon and the anesthesiologist were named in a lawsuit, which was settled for a confidential sum.
Although these kinds of tragic outcomes are rare, there are some important questions to ask your doctor or dentist before you or your child has a “routine” surgical procedure:
• Is the office the right setting for the procedure, or are there medical issues that might make it safer to go to the hospital?
• Who will be giving sedation or anesthesia?
• What type of sedation or anesthesia will be used?
• Will someone other than the surgeon be monitoring blood pressure, heart rate and breathing? (The answer should be yes.)
• Is equipment available if the patient stops breathing?
• Is someone on staff certified in Advanced Cardiac Life Support?
• What is the doctor’s plan in case of emergency?
• Who will monitor the patient’s recovery and supervise their discharge?