Post-surgery
My mother-in-law is 70 years old and has had diabetes for 8 years, with poor kidney function.
Recently, she underwent orthopedic surgery for a hip fracture, but after the surgery, the doctor informed us that she would need dialysis.
She underwent dialysis three days later, then again two days after that, and was discharged with a urinary bag.
However, the hospital did not inform us about the need for dialysis at the time of discharge.
Six days later, she was sent to the emergency room due to pulmonary edema, which progressed to intubation and ultimately a tracheostomy, requiring lifelong reliance on a ventilator.
I would like to ask the doctor if there is a correlation between these events.
Some doctors say that my mother-in-law's pre-existing conditions are unrelated to the surgery, but I believe that prior to the surgery, she did not require dialysis and her kidney function was not severely impaired.
Therefore, I think the need for dialysis was triggered by the surgery.
I hope the doctor can help explain this situation.
I am currently trying to apply for insurance, but the other party's doctor claims that this medical issue is unrelated to the hip surgery, even though it seems to be a complication arising from the surgery.
What should I do now?
Zhang San, 30~39 year old female. Ask Date: 2004/04/06
Dr. Xiao Yongxun reply Internal Medicine
Hello: In response to your question, the coverage of medical insurance is related to the determination of causality, the regulations of the insurance, and relevant measures.
Based solely on your brief statement, it is not possible to provide a definitive explanation.
However, there are two key points to consider.
1.
If diabetes is poorly controlled or has persisted for many years, it can lead to various complications such as nephropathy, retinopathy, neuropathy, coronary artery disease, hypertension, stroke, and atherosclerosis.
As age increases, lung function also declines over the years, and factors such as smoking or air pollution can further accelerate the deterioration of lung function.
2.
Therefore, in the context of diabetes and aging, any surgery, invasive examination, medication treatment, or even sudden outbreaks of influenza or cold weather can potentially lead to irreversible outcomes.
In such situations, determining the causal relationship from both medical and epidemiological perspectives is indeed challenging.
On the other hand, what factors contribute to hip joint pathology? If hip surgery is not performed, what consequences might the patient face? Questions like these require more information and contemplation to answer.
It is advisable for you to discuss these matters in detail with your family physician.
Reply Date: 2004/04/06
More Info
Post-surgery complications, particularly concerning kidney issues after hip surgery, can be complex and multifaceted. In your mother-in-law's case, several factors may have contributed to her current condition, and understanding these can help clarify the situation.
Firstly, it is essential to recognize that patients with pre-existing conditions, such as diabetes and compromised kidney function, are at a higher risk for complications following any surgical procedure. Diabetes can lead to a range of issues, including poor wound healing, increased risk of infection, and impaired kidney function. In your mother-in-law's case, her history of diabetes and existing kidney issues likely made her more susceptible to complications after the hip surgery.
The need for dialysis post-surgery suggests that her kidneys were unable to adequately filter waste from her blood, a condition known as acute kidney injury (AKI). AKI can occur for various reasons, including dehydration, blood loss during surgery, or the effects of anesthesia and medications used during the procedure. If her kidney function was already compromised before the surgery, the stress of the surgical procedure could have exacerbated her condition, leading to the need for dialysis.
Moreover, the development of pulmonary edema and the subsequent need for intubation and tracheostomy indicate that her body was struggling to manage fluid balance and respiratory function. This could be related to her kidney issues, as the kidneys play a crucial role in regulating fluid levels in the body. When kidney function declines, fluid can accumulate, leading to conditions such as pulmonary edema, which can severely impact respiratory function.
Regarding the assertion from some medical professionals that her kidney issues were unrelated to the hip surgery, it is important to consider that while the surgery may not have directly caused her kidney problems, it could have triggered a cascade of events that led to her current state. For instance, if she experienced significant blood loss during surgery or had a reaction to anesthesia, these factors could have contributed to her acute kidney injury.
In terms of pursuing insurance claims, it may be beneficial to gather comprehensive medical records, including pre-operative assessments, surgical notes, and post-operative care documentation. This information can help establish a timeline of events and clarify the relationship between the surgery and her subsequent complications. Consulting with a medical malpractice attorney or a patient advocate may also provide guidance on how to navigate the insurance claims process, especially if you believe that the surgery led to complications that were not adequately communicated or managed.
In conclusion, while your mother-in-law's pre-existing conditions certainly played a role in her post-surgical complications, the surgery itself may have been a significant factor in exacerbating her kidney issues. It is crucial to have open discussions with her healthcare providers to understand the full scope of her condition and to ensure that her ongoing care is appropriately managed.
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Related FAQ
Renal Dysfunction
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Kidneys(Internal Medicine)
Postoperative(Urology)
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