Should you elect to operate?
Risk of virus exposure should be weighed against chance for relief from ailment
With theCOVID- 19 pandemic raging across the country, many people hoping to undergo elective surgery can expect their operations to be on hold indefinitely. Hospitals in many places are at or near bed capacity and facing staff shortages. Even facilities still able to handle operations not considered urgent are likely to experience cancellations when patients themselves, fearing contagion, postpone the procedures.
My brotherwas scheduled for a total knee replacement mid- December in upstateNew York. But when three stores he frequented closed because employees got COVID- 19 and the community’s infection rate climbed through the roof, he opted to reschedule the procedure.
Better to risk missing another season of tennis than to miss his daughter’s wedding in the spring and old age altogether. As a 75- year- old who had openheart surgery two years ago, he knows he’s highrisk for a life- threatening COVID- 19 infection. Even if an overnight hospital stay were not a risk, he feared possible exposure to the virus during theweeks of rehab afterward.
Two ofmy friends scheduled for elective surgery managed to sneak under the wire this fall; one had a knee replacement in early October and the other a hip replacement in earlyNovember. But if you or a loved one is on a surgeon’s schedule for a similar optional procedure in theweeks ahead, youmaywant to rethink your plans, depending on where you live.
In a list of "guiding principles," the American Academy of Orthopaedic Surgeons cautioned its members that during the pandemic, decisions to proceed with elective surgery "should be locally based" and take into account "incidence, prevalence, patient beds, hospital beds, ventilators and personal protective equipment," in addition to local shutdown orders and whether there has been "a sustained reduction in new cases of COVID- 19" in the area.
Likewise, there are many issues for prospective patients to consider before proceedingwith an elective operation. First and foremost is an understanding of what "elective" means and whether there are less risky alternatives to consider, at least until the pandemic surge abates or most Americans are protected by a vaccine.
Elective surgery means it is not urgent. The condition requiring surgery may be life- limiting and compromisewell- being, but it is not life- threatening or in imminent danger of becoming so. Thus, fixing the problem surgically can be safely postponed.
However, "elective" may not be the most apt description for people with frequent or constant pain that inhibits their ability to function on all cylinders. A better term may be "nonurgent," but even that can be a problem for someone who lives alone or is unable towork productively.
Still, even some patients with clogged coronary arteries or a cancer considered low- risk can often delay an operation until surgery and aftercare becomes less risky.
You mightwant towait until the hospital staff has had a chance to recoup. As three experts pointed out, "basic human factors, exacerbated byCOVID- 19, can threaten the safety of patients and staff." Dr. William Berry, a research scientist at theHarvard T. H. Chan School of Public Health; Dr. KedarMate, president of the Institute forHealthcare Improvement; and LindsayMartin, a health policy instructor at theHarvard public health school, listed fatigue, lack of routine practice, distraction, overload and emotional stress as medical staff issues that could compromise patient care.
Anyone anticipating elective surgery can make use of the extra time to become better informed and better prepared for the operation, starting with a very basic question: Do I really need this surgery? Have you exhausted other treatment options, like oral and topical medications, physical therapy and athome exercises?
Ask about the surgeon’s experience with the operation. Howoften does the surgeon perform it, with what success rate and what kinds of problems do patients report? Youmight ask to speak with a previous patient.
Youmay be aware of the potential benefits of surgery, but are you equally well- versed in its risks and possible complications? And do you knowhowto minimize these, say, with strengthening exercises, weight loss or dietary adjustments?
Is there anything in your health history that could make the surgery riskier than usual? Are adjustments needed in the medications you usually take? If you take any medication, even baby aspirin, that thins the blood, were you warned to discontinue it well before surgery? If you have diabetes, what will be done to make sure you maintain a safe blood glucose level before and during the operation?
What are your options for anesthesia? Is a general anesthetic necessary or might the surgery be done under a regional or local anesthetic? Make sure the anesthesiologist knows if you’ve had a prior adverse experiencewith anesthesia.
What can you expect in terms of recovery from the operation? When might you be able to return to your usual activities, includingwork, lifting, driving, exercising? Here’s where you need to prepare for theworst while hoping for the best. Surgeons tend to provide patientswith the best possible outcome, often leaving them unprepared and frightened when their recovery is not as smooth or as fast.
What sort of personal assistance might you need when you return home, and for howlong?
Postoperative medications, which nearly always include drugs to control pain, can be challenging. They can cause dizziness, upset stomach, constipation and other distressing side effects. Make sure you knowwhat reactions to expect and howto minimize them.
If you will need physical therapy, howwill this be arranged? Can a therapist come to your home for the first fewweeks? When you’re better able to navigate, where can you go to get further therapy? The quality and extent of physical therapy can be at least as important as the surgeon’s expertise in determining the result.
Finally, don’t forget cost! Will your insurance cover all or most of the expense? Does your coverage include postoperative rehab? If your insurance is limited, youmay be able to negotiate a payment plan with the surgeon.