Surgery in the Time of Covid


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’s been “a sustained reduction in new cases of Covid-19” in the area.

Likewise, there are many issues for prospective patients to consider before proceeding with 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 compromise well-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 to work 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 might want to wait until the hospital staff has had a chance to recoup their pre-Covid stamina. As three experts pointed out, “basic human factors, exacerbated by Covid-19, can threaten the safety of patients and staff.” Dr. William Berry, a research scientist at the Harvard T.H. Chan School of Public Health, Dr. Kedar S. Mate, president of the Institute for Healthcare Improvement, and Lindsay A. Martin, a health policy instructor at the Harvard public health school, listed fatigue, lack of routine practice, distraction, overload and emotional stress as medical staff issues that could compromise patient care.


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