HAI and elective surgery

July 16, 2010 1:27 AM

I am considering elective (plastic reconstructive) surgery and I am concerned about hospital acquired infection (HAI). One possibility is to have the surgery in Holland or Denmark where, as I understand it, the rates for HAI's is low compared to elsewhere. How do hospitals in these countries compare with those in the U.S. with respect to HAI and prices for services?

Have you had surgery in Holland or Denmark? What was your experience?
Are you a doctor with knowledge re HAI's in the U.S. and Europe? What do you think?
I have tried to find this info on the net with only limited success.

posted by noonknight to health & fitness (7 answers total)

I had elective plastic surgery in a Dutch (private) hospital and had no issues, but I would have no idea about rates of hospital-acquired infection or anything like that. I didn't catch anything, is all I can tell you! To be honest (and not to dismiss your particular concerns, not at all) it seems a bit of a random thing to pick out of all the potential problems involved with surgery and recovery.

I would also be a bit leery of having elective surgery in a country where I didn't speak the language/wasn't familiar with the culture. Prices for services may well be cheaper here (I don't know how much things cost in the US), but you have to factor in recovery time, travel time and costs, returning for checkups if things go wrong, so I'm not sure how much you would save in the long run.
posted by rubbish bin night at 1:40 AM on July 16, 2010

You may be more worried about this than you ought to be.

True, an estimated 1.7 million people in the US got what is called a "nosocomial infection" last year. However, there are three characteristics of the vast majority of them which don't apply to you:

1) They were in hospitals. Many if not most elective plastic surgeries are performed in outpatient clinics not attached to a hospital, i.e. you'll be going in for your surgery but going home that same day. I'm unaware of any significant number of nosocomial infections from outpatient procedures. It's just not something anyone's worried about.

2) They had compromised immune systems, either because they had some specific medical condition which caused it--AIDS, immunosupressant drugs, radiation therapy, etc.--or because they were just old. You--presumably--aren't either of those things, and plastic surgery will not change that.

3) They had invasive machines and implements attached to them, i.e. catheters, ventilators, etc. You won't.

So right there, you've eliminated the three biggest risk factors for nosocomial infection already. I'd say the likelihood that you'll be inconvenienced by the fact that you're having surgery performed thousands of miles away from your support system is far greater than that of getting any kind of infection.

Besides, most surgeons put patients on prophylactic antibiotics anyways, so the risks really are pretty minimal.
posted by valkyryn at 2:56 AM on July 16, 2010 [4 favorites]

Also, the single main factor in surgical outcome is the quality of the surgeon. You'd leave the US (which does have the best surgeons in the world) and your own medical provider and network and fly in a little metal tube over the ocean to have some Dutch or Danish surgeon you've never met before cut you open out of fear of nosocomial infection risks in the US?

That is magical thinking. Seriously, your risks of dying under anesthesia or the surgery going badly and disfiguring you are much higher than the risk of HAI no matter where you get it done. Risk assessment requires rationality.
posted by fourcheesemac at 4:32 AM on July 16, 2010 [2 favorites]

Conversely, at a large hospital in NYC, I had 8 surgeries over two months earlier this year, including a double nephrostomy (meaning I had tubes coming directly out of my kidneys for a month), and was in the the hospital for a total of three weeks. I did not get a HAI.
posted by kimdog at 5:05 AM on July 16, 2010

Seriously, your risks of dying under anesthesia or the surgery going badly and disfiguring you are much higher than the risk of HAI no matter where you get it done.

Okay, I'm all for rational risk assessment--it's actually what I do for a living--but that's just not true. Way, way more people get nosocomial infections than die under general anesthesia, i.e. where they actually anesthetize you to the point that you need a ventilator. The mortality rate is something like 1 in 250,000 or less.

Even better for the asker, plastic surgery is almost never done under general anesthesia. They tend to do regional anesthesia combined with sedation. These are almost entirely safe, as neither of them affects the body systemically the way general anesthetic drugs do.

Indeed, the fact that plastic surgery does not involve general anesthesia is part of what makes nosocomial infection so unlikely: there are far fewer invasive devices involved.

Also, depending on what you think about plastic surgery, the chances of disfigurement might be close to 100%. I kid, I kid...
posted by valkyryn at 5:25 AM on July 16, 2010

Not a direct answer to your question, but something you should think about: If you're an American, you may not be able to have elective surgery elsewhere due to group B strep and other bacteria.

I had to visit a hospital in Iceland for a problem that was medical, not surgical, and did not involve any contagious illness on my part. I was kept in strict quarantine simply because I am an American and we have been exposed to - and developed immunity to - bacteria that simply do not exist in Iceland and can pose serious complications to other patients with compromised immune systems.

I have no idea how things work in Holland or Denmark, but one way that they might try and keep HAI down is to keep people who have been exposed to harmful bacteria out of the system to start with - and Americans are pretty high up on the list of people who have been exposed. Not to freak you out - but you could be harboring group B strep and not even know it and it will probably never make you sick. But if you were on a surgical ward... yeah, it could spread to others and cause a serious problem.

Be sure to find out #1) if you're a carrier and #2) what the policies are in the country where you want to be treated w/r/t Americans as potential carriers. Like I said, in Iceland there were very, very strict rules (i.e., ANYONE entering my room had to "scrub in" and wear a gown and mask - simply because I'm American) about Americans being treated in their hospitals.
posted by grapefruitmoon at 5:48 AM on July 16, 2010

If you do not speak Dutch or Danish, do not underestimate how challenging this will make a hospital stay. It is hard enough to communicate while hospitalized, and I wouldn't depend on everyone knowing English.

The type of anesthesia you have and whether you can have the surgery done in an outpatient setting depends on what exactly you are planning to have done. For example, if you are having a post-mastectomy breast reconstruction, you will likely have to be hospitalized and have general anesthesia.

There is a wide range of HAI rates among hospitals in the US. Some do very well with preventing transmission, and others do more poorly. Even within the same hospital, different nursing units may have better or worse transmission rates, and transmission rates of different kinds of infections with different transmission vectors may vary.

It can be difficult to get specific HAI data about US hospitals, but you can see if a hospital is consistently taking the right actions to prevent HAIs at Hospital Compare. Look at the Process of Care measures - the surgical measures are first on the list. These data are reported to and complied by the federal Department of Health and Human Services.

There are some things you can do as a patient to limit your risk. First, make sure everyone who comes in your room washes their hands or uses the alcohol gel. They should do this in front of you and it is OK to ask about it if they don't. Second, get off any invasive devices (like catheters) as quickly as possible. Third, leave the hospital as soon as you feel able to do so.

One of the most important factors in your surgery is the surgeon. Since this is an elective procedure, shop around. Ask for references and follow up on them. Get a second (or third) opinion on the best procedure to get the results you want. Find the surgeon who does the highest volume of that procedure (the more often a surgeon performs a particular procedure, the better they typically are at it).

This doesn't necessarily answer your question, but I think going to another country for this procedure based on concerns about HAI misses how you can be an effective advocate for yourself and help assure the best outcome.
posted by jeoc at 7:19 AM on July 16, 2010