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Crohn's Disease Forum » Surgery » Where to have surgery?


03-29-2012, 12:49 PM   #1
BoFin1
 
Join Date: Sep 2011
Location: Michigan
Where to have surgery?

I just found out that I will definitely need a colon resection, and it will be my first surgery. I want to here from others how they decided where to have surgery, and get some input so I can decide what to do.
Here are my options:
1) Large univeristy hospital with excellent reputation. I have received good care there for 11 years. The drawbacks of surgery here is it is a 45 minute drive, everything is a big process and takes a long time. Even simple things like parking take forever since I must drive around the parking structure and always end up on the roof.
2) There is a brand new IBD center only 3 miles from my house, and I went there today for the first time. I had zero waiting time for my appointment, so after surgery this is a bonus. Hospital is only 10 minutes from me. It is also an excellent hospital and smaller than the university hospital. Advantages are that it will be a lot easier for my friends and family to visit me. Also, since I won't be able to drive after surgery for appointments it will be closer to home than option #1 for people to drive me. In case of emergency after surgery, it is closer than hospital #1.
Disadvantages- the doctors there don't know me, so maybe it is better to stick with a hospital and doctors that have known me for a long time while I am going through something major like surgery.
Do you think it is a problem from a medical perspective to have surgery at hospital #2 , but after I am healed go back to hospital #1 fo continuing my care? Would I get better medical care if I just stick with hospital #1?
If I go to hospital #2 for surgery, should I just continue there as a patient, would my medical care be better?
I really like my GI doc at hospital #1 and don't like the idea of leaving. However, the whole surgery experience would be much more convenient for me and my family at hospital #2
03-29-2012, 02:19 PM   #2
Heather_D
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Hi BoFin, My surgery was at a hospital 45 minutes from me that sounds a lot like your Hospital #1; however I didn't have a closer option with the same level of expertise. The hospital I went to had one of the best colon and rectal surgical teams in the area and the local hospital recommended I have the surgery there when I was admitted in February due to complications. I would personally go with the one with the most experience. My surgeon had over 20 years of experience and teaches the surgery to newer doctors. He was able to do my surgery laparoscopically; which I think other surgeons with less experience may not have been able to complete the surgery this way as I had additional complications once they opened me up. I think it can be beneficial to have your GI specialist and surgeon in the same hospital, but not necessarily a requirement. I just think if the doctors are in the same facility it will be easier for them to share information regarding your treatment. I would also have a hard time leaving a GI doctor I really liked. I actually just started with my third with all of this. I never cared much for my first and liked the second doctor until I felt she had run out of suggestions on how to treat me. So, I'm now with a GI specialist in the same facility as my surgeon. Yes, its 45 minutes away, I have to pay to park, and it takes longer to get an appointment; but I feel that the doctors are excellent so I'm hopeful that they will be able to keep me in remission now for a while.

If you feel the team at Hospital #2 has the same level of expertise and you trust the doctors than it could definitely be beneficial to have them so close. Otherwise, I would stick to the hospital that you know and has treated you well for the last 11 years.
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Diagnosed: Crohns Oct 2006
Prior Meds: Pentesa 4000 mg/daily; Cimzia 400 mg/monthly; Prednisone off and on from Aug 2011 - March 2012
Current Meds: Apriso started 4/14/2012
Surgery: Laparoscopic Ileocolic & Rectosigmoid Resection March 22, 2012
03-29-2012, 02:57 PM   #3
DustyKat
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I agree with Heather. I would go with the best surgeons.

To be honest when it comes to surgery I don't know that it is a huge difference whether the docs know you that well or not and I only say that because both of my children had surgeons that did not know a lot about them.

My daughter had emergency surgery in our local hospital, small rural, she was undiagnosed at the time. So we had the advantage of the hospital being 20kms away. The surgeon was unknown to us.

We had a diagnosis and time on our side for my son. We were given the option of our local hospital or a very large teaching hospital with specialist colorectal and IBD surgeons. We chose the latter and it was 600km away from where we live.

Given the choice I would always choose expertise over convenience. To me physical outcomes are the most important thing BUT psychological health can be just as important so if you have good surgeons and will have greater peace of mind being closer to home then that must be taken into consideration.

Dusty. xxx
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03-29-2012, 03:45 PM   #4
PsychoJane
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Hello!
I agree with Heather and Dusty about choosing the experience over any related inconvenient. I don't know how it works where you live but I assume that the doctors must know about others reputation. So maybe that your actual GI knows of some specialists/surgeon that pratice at the ditto IBD center. I know my GI had no problem with me asking to get surgery in another hospital (which I asked for because my first surgery was there and I loved the surgeon and it was also more convenient for me because of its localisation). Maybe your GI would be opened to that type of arrangement [Health care is public here so it is usually not a problem, I assume it's not the same everywhere?] , assuming that there's a strong team (or not) at the IBD center?
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03-29-2012, 04:20 PM   #5
BoFin1
 
Join Date: Sep 2011
Location: Michigan
Thanks to everyone who wrote. You are right, the reputation is most important.
I will have to meet surgeons from both facilities, and check them out with the licensing board. For people who live in the USA, where do I check to find out if my surgeon has any litigation against them or any complaints with the state licensing board? I live in Michigan.
One thing that I like about hospital #2 is that this GI doctor trained at
the university hospital #1 and knows my doctor. However, what really counts is the surgeon.
For those who had surgery in a place different from where your regular GI is, was it a problem to continue care with your regular GI after surgery?
03-29-2012, 04:28 PM   #6
DustyKat
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I don't know how things work in the US but if everything goes according to plan you normally only have one post op visit to the surgeon following discharge, at about 6 weeks, and then you are handed back over to the care of your regular GI.

Dusty.
03-29-2012, 04:48 PM   #7
Heather_D
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I'm not sure where to go to look for pending litigation against a surgeon as I didn't look since he came so highly recommended, I had the surgery done in Massachusetts. My surgery was 3/22 and my follow up is scheduled for 4/13. I have been doing really well (I haven't even needed any pain meds since early Monday morning), so I'd be surprised if I had to continue seeing the surgeon after that appointment. The last thing I will need from his office is a release to go back to work.
04-14-2012, 03:40 PM   #8
Switalski
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BoFin1,
The main question you need to ask the surgeon is, "How many colon recections do you do per week?" You want the the man or woman who does these things every week. If he or she does them every once in a while, move on. Forget about parking and distance becasue none of that matters when you are in surgery. The experience of the surgeon is the most relevant factor when it comes to success. As ana aside, I don't see how you are going to beat the experience at the large teaching hospital.

I just had a right hemicolectomy at the Mayo Clinic in Jacksonville, Florida last week. It's a 2.5 hour drive from my house. The #1 factor was the experience of the surgeon and his team.

As for follow up care with my GI, that's the way it is planned. The surgeon will most likely tell you up front that he is not there to give you continuing care. He is there to perform the surgery, that's it. Continuing care, maintenance medications, etc. are for your GI.

Good Luck!
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04-14-2012, 04:19 PM   #9
BoFin1
 
Join Date: Sep 2011
Location: Michigan
Thanks for writing. I agree with you and what everyone else has said.
I am now 90% sure I will go with the surgeon at the large teaching hospital. I will see her on April 18th and decide for sure once I meet her.
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