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the years 1990 and 2000. These subjects underwent CABG (coronary artery bypass graft). The average age of the men was 63 and the average age of the women was 66. One enigmatic result of that study is that 22% of women are more likely to die after CABG than men! This article is based on my observations about how women while they are treated undergoing open heart surgery. At times women, because of their body fat, are deemed difficult cases because it may be harder and more labor intensive to harvest arterial conduits (internal thoracic mammary arteries, radial arteries) for bypass grafts. The difficulty is due to smaller vessel size (women are smaller than men!), the time and effort involved in the dissection procedure, and other factors. As a result of my observations and research I was able to write the following not as an alarmist but to provide information. The following actions may save your life. Do your research to find the best cardiologist and surgeon for your specific heart problem. Specialization in heart surgery means that some heart surgeons do certain procedures better than others, because THEY DO MORE! Just because your surgeon or doctor is nice to you in the office, does not mean that he or she is qualified to do your procedure. Do your research to find the best practitioner for your insurance dollars or your personal dollars if you are paying cash. Some surgeons simply are not proficient in cases that they do not routinely do on a weekly or monthly basis. Examples of some of these cases are: reoperations, combination reoperations and concomitant valve surgery, myectomy for IHSS, and primary CABG. Reasons a surgeon may not be surgically proficient in more difficult procedures are because of the lack of volume of cases and type of cases that a surgeon does in a year’s time, as well the auxiliary resources (skilled and experienced nursing, a dedicated cardiac unit, intensivists, anesthesia, and perfusionists, etc.) Smaller hospitals tend to do very healthy (relatively speaking) first time surgeries with practically no other serious disease factors and/or processes in play. The surgeon and hospital may do these types of primary cases to keep their mortality rate down. An increase in the hospital’s or surgeon’s mortality rate affects both entities adversely; financially as well as their reputations. Furthermore, if things do go bad in one of these institutions and the patient winds up with a prolonged stay in the OR the intensive care postoperatively, the patients insurance may not pay beyond a ‘reasonable’ cost. The hospital may have to take the ‘hit’ for costs beyond reasonable or go after the patient for what may be an incredible amount of money. Sometimes, the patient unfortunately dies. Even in a heart center like The Cleveland Clinic, there are heart surgeons who perform some surgeries slightly better than the others because it becomes their specialty! A particular surgery may be one that he or she performs exceptionally well. That is the surgeon you want. For instance, a surgeon may be well known for mitral valve surgery, or renowned for doing reoperative CABG’s; that is the person you want. As stated above, and repeated here because of its overarching importance, a particular hospital may not have the required highly trained nurses, cardiologists, diagnostic technology and equipment, surgeons, and auxiliary personnel for the preoperative, intra-operative, and postoperative course a patient will require.
View your doctor and surgeon as independent contractors. You, the patient, are paying them! It is their privilege to serve you. Doctors need patients in order to practice medicine and make a living. Go to the largest, best teaching heart center or hospital in your area. If necessary go outside the state, or the country. Why? A larger facility will have the exposure and experience in treating a large number of patients with varying degrees of heart disease problems. Also, patients now present acutely (particularly women) to the hospital with a number of disease processes in play as well as the prime offender of heart disease. Concurrent diseases such as diabetes, renal disease and failure, patients on IABP (intra-aortic balloon pumps), LVAD (left ventricular assist device), carotid disease, previous heart operations, and other forthcoming surgeries to name a few, are medical situations a larger heart center may be equipped with professional staff and technology to handle. Because of a facility’s experience and success in diagnosing, treating, and surgical intervention, your presentation for your specific heart malady will be handled more proficiently (a thorough and quick diagnosis alone can save your life!). Go to the largest heart disease center that routinely operates on patients from around the world. Why? Because these institutions will have the diagnostic and operative experience with differences in vasculature (typically peoples from Asia and the Middle East have smaller arteries and veins) and other rare and odd heart disease processes. Also, foreign patients for the most part pay CASH. They come to a certain institution by referral generally because it’s the best place to treat their problem. Think about it, someone who pays cash can afford to go anywhere in the world, yet they have chosen a particular institution based on its successes and the expertise of its staff. Invest in and develop a professional and emotional bond with your REGISTERED NURSE before and during your hospital stay. This includes the floor nurse, the OR nurse, and the intensive care nurse. Your RN is your partner in helping you achieve your most optimal course of care and recovery. He or she is your most vocal, profound, and proximal patient advocate, and your first line of defense against untoward events on the floor, in the OR, and in the postoperative intensive care unit. Registered nurses are highly trained, educated, and technologically advanced practitioners. Nurses routinely and unobtrusively perform over 100 assessments on a patient. Some of the assessments occur while the nurse is having a casual conversation with the patient. These assessments, coupled with patient advocacy and articulating a course of action between the patient and nurse and at times the patient’s family, could mean the difference between recovery and tragedy. Women need to ask their doctor, their surgeon, and their cardiologist what their quality of life will be after a heart procedure. Also ask about the emotional and social resources that are available to help you combat the anxiety (before and after), depression, and feelings of helplessness that many women experience after heart surgery? Women, particularly older women, generally experience more anxiety and depression after surgery! As women we tend to be nurturers, but many women do not put into place a system for their own nurturance before and after major life altering surgery! Network, make friends, do everything you can to ensure your best quality of life after such a major procedure!
Find out how your surgeon, your doctor and cardiologist plan to decrease the possibility of you having a stroke before, during, and after your heart surgery— particularly after. Women have a higher stroke risk after heart surgery than men! BE FEISTY! Not arrogant, not mean, or nasty. Be knowledgeable about your procedure. Expect and then demand that healthcare persons interacting with you identify themselves to you, talk to you and not around you in the third person. Make sure that anyone you talk with (surgeon, nurse, cardiologist, housekeeping) answers your questions and concerns with respect and in understandable terms. Come into the hospital fighting for your life...because you are! Author, Adrienne Zurub was a cardiothoracic RN on the open heart/heart transplant team at Cleveland Clinic with over twenty-five years of open heart experience. Ms. Zurub is a CNOR (certified nurse operating room) with a bachelor's degree in Psychology, a master's degree in Philosophy as well as her nursing degree. She is the author of 'Notes From the Mothership ~ The Naked Invisibles, a nonfiction work that incorporates and coalesces elements of her open heart experiences with other aspects of her attentive, and at times randy life. Zurub is a Speaker belonging to NSA (Ohio chapter).
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