PA assisting my surgeon was a surprise

Posted by AmericanPatriot @USA @tennisgolf, Apr 11, 2019

I have had 2 Total Knee Replacements and both were successful, not than painful, recovery was easy and I worked HARD before and after to strengthen my body. I am in my 70's. 2 different surgeons and 2 different hospitals. I asked in both cases for the surgery report. I was surprised that during the most recent TKR, a PA did some of the procedure! Shouldn't I have been told of this? Report says "due to the complexity of the case, the first assistant was required. He did retraction, performed certain bone cuts, performed final stages of wound closure, application of the dressing." This was a sought-after surgeon at a VERY well-known, respected East Coast hospital. The surgeon said "I was present for all aspects of the case." "There were no other attending, fellows or surgical residents available to scrub." WHAT SHOULD I MAKE OF ALL THIS? I know people will say, be happy, it was a success. But my point is I carefully researched and chose this surgeon. Shouldn't he have done the surgery?

@tennisgolf I am glad you have had good results from your knee surgeries. In response to your concerns regarding the person that did the actual hands on . . . It is customary for long/involved surgeries to have a secondary surgeon (first assistant), or even several, to make sure the patient is well cared for; the surgery is done as quickly and efficiently as possible; and to be able to do more than one step at a time. For example, the first assistant did refraction. This means that the first assistant held the edges of the wound open so that the bones could be reached and worked on. For a knee the bone above the knee and the two bones below the knee all need to be cut/trimmed to accept the replacement. It is highly likely that the first assistant ran the saw while the primary surgeon made sure the bone was held in exactly the correct position and could watch from a different angle for any possible problems. The master directing the technician in running the tool. As far as wound closure, stitches are placed close to the bone, and all the way out of the wound, culminating in the skin closure. It is reasonable and usual protocol primary surgeons to hand off closure to the assistant. Much in the same theory as you wouldn't use a cement drill to sew a button on. The surgeon made note of the fact that he was there and responsible for the entire procedure. I do not see anything unusual in this report. I hope this information can help you get more comfortable with the care you received and not doubt the discretion of the surgeon. Take care.

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Yes, I get a little crazy about these things. I hear you. The statement "There were no other attending, fellows or surgical residents available to scrub" – what is the meaning? Sounds like they were short of staff (?) Are you a medical professional? Thank you for your explanation – it has helped significantly already.

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@tennisgolf I am glad you have received some comfort from my interpretations of the wording. "No other attending" to me means that at that point in the surgery the surgeon and the first attendant were the only surgeons in the room. That does not mean that there were no others during the surgery, but toward the end (closing) the primary concerns are past and it is just basically wound care to finish. Other surgeons may have been busy with other surgeries or just not in the operating arena at the time. I would not interpret it as short staffing. Being a respected surgeon he would not go into surgery without a plan for contingencies.
I am not a medical professional, I do however have multiple health issues that I deal with for my parents, self, children and friends. I do a great deal of personal research to understand and best help everyone through whatever they are dealing with at the time. I did work at a hospital and had contact with physicians and nursing staff on a daily basis. I was responsible for writing and maintaining the nursing policies and procedures, so I picked up some information there. My husband also worked in the Lab and between the two of us we have gathered more than usual amounts of information.
I am just sharing my interpretation of phrases I have seen or heard before and how they were explained to me. Glad to be able to help.

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@tennisgolf

Yes, I get a little crazy about these things. I hear you. The statement "There were no other attending, fellows or surgical residents available to scrub" – what is the meaning? Sounds like they were short of staff (?) Are you a medical professional? Thank you for your explanation – it has helped significantly already.

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@tennisgolf I hear what your concern is I have worked in the operating theater as a scrub nurse you have the surgeons,anesthesiologist another room nurse so it's not that there isn't anyone else there ,when the primary surgeon is done operating its not unusual to let the other surgeon close up for his especially if he is called out on a emergency .All the Dr,s and everyone concerned have that person's best interest at heart.

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This "JUST WANT TO TALK" forum is just the BEST!! I much appreciate all who have responded. I am a person who always asks many questions; I love research; and I am also a tad cynical about many things. I feel quite reassured after all the responses and the content of the responses. You know, this is precisely what is missing in the medical profession today. It is the opportunity to talk with any doctor for more than a nanosecond (exaggeration) about any B-I-G or small procedure. They are pressed for time and both they and the patients suffer. I do my own research, but I still need to know the doctors are "paying attention" to any patient's well being. It may be "just another day at the office", but for the patient not to be curious and to raise issues is, I believe, sometimes just too naive and trusting. Better to let the professionals be aware we are informed – even though it may not be necessary. Perhaps they respect patients who want to know. This is where the NURSING staff is really helpful as well. They are often more tuned in to concerns of patients. I am fascinated by surgery reports on what transpired and it helps me understand the process. Thanks to all of you and best wishes for good health.

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