High cost vs. low cost spays and neuters: What’s the difference?
If you have a dog or a cat, chances are you have considered spaying or neutering them. It is generally recommended for dogs and cats that aren’t intended to be breeding animals to reduce unwanted litters and to reduce the chances of various other health issues.
You may have also seen that there can be a wide range in the cost of these services! I work as a general practice surgeon in many hospitals where the surgery costs are different.
Even though the costs of these spays and neuters may vary, as the surgeon I do each spay and each neuter the exact same way and in about the same amount of surgical time every time. So why do these cost differences occur? It is primarily due to variations in anesthesia protocols, pain control, and support staff.
What is the process for general anesthesia?
To understand these cost differences, it is important to have a general understanding of all the things that go into a safe anesthetic and surgical procedure.
Prior to the procedure, your pet will likely have blood work performed to ensure that their organs are healthy enough for anesthesia. Your pet is given a pre-medication to help him or her relax, and this pre-medication cocktail also typically includes something to help control pain.
An intravenous (IV) catheter is placed so that we have IV access to administer additional anesthetic drugs, fluids during surgery, and for emergency drug use if a pet should experience complications while under anesthesia. We may also use the IV catheter to give an anti-emetic (anti-vomiting) medication to greatly reduce the risk of vomiting while under anesthesia, as many of our anesthetic drugs can make patients nauseous.
Then, anesthesia is induced by giving a heavy sedative through that IV catheter, and an endotracheal (ET) tube is placed to protect your pet’s airway and to administer inhaled gas anesthesia. That ET tube is then connected to our gas anesthesia machine, where both oxygen and anesthetic gas is given continuously throughout the surgical procedure.
During this time, your pet is typically hooked up to monitoring equipment that keeps track of their heart rate, respiratory rate, blood oxygenation, blood pressure, and temperature.
All of these monitoring parameters help us to keep your pet at the right plane of anesthesia, where they are asleep and unable to feel the procedure, but are not so deep that they are at risk of having anesthetic complications. Once the procedure is complete, the gas anesthesia is turned off and your pet is monitored until they are awake enough that we can safely remove their ET tube.
Cost differences related to blood work
Let’s first look at where cost differences can occur due to variations in pre-anesthetic blood work.
The most expensive panels of blood work will include a complete blood count (measuring the red and white blood cells and platelet levels), an extensive chemistry (measuring the liver and kidney values and electrolytes), and clotting times (measuring how quickly blood clots).
In cats, the most expensive panels may also include a test called the proBNP which measures stretch and strain on the heart muscle, as cats can have heart disease without signs of it on their preoperative physical exams.
Surgery costs can be reduced by doing smaller panels of blood work that give us less information, or by eliminating preoperative blood work altogether.
If a dog or cat has changes to their liver or kidney values, platelets, clotting times, or proBNP, it may change the drugs we use, or it may even lead us to delay surgery to investigate further. If blood work is not performed and we do not have this information, it could result in inappropriate drug selection or surgical complications (like excessive bleeding) that were avoidable.
Cost differences related to anesthesia/drug protocols
Next, let’s investigate the various anesthesia and drug costs.
In well-balanced anesthetic procedures, we use “multi-modal” anesthesia. This means that we are using multiple different drugs to achieve a good plane of anesthesia, which allows us to use lower doses of each drug, and ultimately lower levels of gas anesthesia. This reduces the risks of cardiac and respiratory complications during and after surgery. These drug combinations must be tailored to each patient to achieve the desired level of sedation while reducing the undesired side effects.
In addition to sedatives and pain medications, higher cost procedures will often include a medication to reduce the risk of vomiting. Many of our anesthetic drugs can cause nausea and vomiting under anesthesia can lead to serious complications like aspiration pneumonia — this can be deadly if not caught and treated early.
Adding in an anti-emetic medication to reduce the risk of vomiting ultimately reduces the risk of complications like aspiration pneumonia. To reduce costs, hospitals may carry very limited sedative drugs, may use a standard drug protocol that is not tailored to each patient, and may eliminate the anti-emetic medication.
Cost differences related to pain control
Now, let’s check out the differences in cost due to varying pain control protocols.
A well-balanced pain control protocol will include several different types of pain medications. Oftentimes an opioid will be used as part of the pre-medication. There are various types of opioids ranging in cost and efficacy of pain control — typically the cheaper opioids are less potent and provide less pain control.
For spays and neuters in young, healthy dogs, we will also use an injectable non-steroidal anti-inflammatory (NSAID) medication. The opioid and NSAID combination help to keep your pet systemically comfortable throughout surgery and recovery.
Other pain control options include local or regional nerve blocks. For spays, we can numb the skin where the incision will be made and use a “splash block” where a numbing agent is put directly into the abdominal cavity so that the surgical site is not painful during recovery.
For neuters, we can use drugs to block nerve sensation to the testicles so that they do not feel any pain during surgery or recovery. All these methods of pain control add cost to the procedure, and some, if not all of them, may be skipped in order for a hospital to reduce the overall surgery cost.
Cost differences related to support staff
Lastly, let’s look at differences in cost due to support staff.
To keep your pet safe during surgical procedures, the veterinarian typically has support staff members to help with monitoring the patient at each stage of anesthesia and recovery. For optimal safety, there should be a support staff member with your pet from the time they are pre-medicated until they are extubated (their ET tube has been safely removed from their airway).
Additionally, it is ideal for this support staff member to be a licensed or registered veterinary technician (LVT or RVT). LVTs and RVTs have received specialized training in anesthetic drug use and anesthesia monitoring, and they also have received training on how to respond during an anesthetic complication.
Some of the ways hospitals can reduce the costs of their surgeries is by reducing the number of support staff that they have working, or by using support staff members for surgery that are not licensed or registered technicians.
In these scenarios, your pet may be left unattended throughout some of the anesthetic process to try to increase the number of surgeries while keeping staff costs down.
Additionally, the person monitoring your pet may have minimal training on appropriate anesthesia monitoring and may not be equipped with the knowledge needed to alert the veterinarian if a problem is developing.
Next time you’re reviewing a spay or neuter estimate, instead of asking why your vet’s spay estimate is so much more expensive than Clinic X’s estimate, take the time to ask about what is included in the cost and what their anesthetic protocols are like.
Ask what types of pain medications will be used to keep your pet comfortable. Ask if a licensed technician will be with your pet throughout the procedure. In most cases, the increased cost is worth it for the added safety and comfort of your pet.
Dr. Courtney Norjen is an Associate IndeVet practicing in Virginia and Washington, DC.