The ACS guidelines have sparked some confusion over what qualifies as an elective surgery. Elective does not mean optional, or that a person has a choice over whether or not they need the surgery, but rather describes the amount of time they have to get that procedure done. “Emergency surgery is performed when there is an immediate threat to life or limb. Everything else is elective, but that certainly doesn’t mean it isn’t medically necessary,” says Robert Cima, MD, a surgeon at the Mayo Clinic. This means even some cancer and heart surgeries are being delayed if doctors deem that having surgery in a few months won’t make a person’s prognosis worse.
Why Are Elective Surgeries Postponed?
According to the ACS announcement, pushing back elective surgeries will allow hospitals to conserve critical resources, including hospital and intensive care unit (ICU) beds, respirators, and personal protective equipment (PPE) like gloves, masks, and gowns, that are both essential pieces of medical supplies and in short supply worldwide. “We are at the beginning of an epidemic that is only going to get worse from here,” says Eric Jensen, MD, head of the division of surgical oncology at the University of Minnesota in Minneapolis. “And as this epidemic gets worse, we need to conserve resources so when the peak happens over the next month or two, we have enough resources to take care of everyone who needs to be in the hospital.” RELATED: Coronavirus Glossary: Key Terms About the Pandemic Explained People who are in the hospital for conditions unrelated to COVID-19 are also among those who have the highest risk of developing complications related to the virus — people with cardiovascular disease or cancer patients, for example — so the risk of these people dying from COVID-19 complications is high. Being in recovery from an operation also puts patients at a higher risk for complications. “The last thing we want to do is expose these people to unnecessary risk over a surgery that can safely be postponed,” says Dr. Jensen. Although hospitals have strict protocols for keeping respiratory patients away from other patients, Jensen notes that it has become even more important to keep people out of hospitals when possible. The Centers for Disease Control and Prevention (CDC) recently estimated that as much as 25 percent of people who have COVID-19 do not show any symptoms, meaning there is an increased potential that people would unknowingly bring the novel coronavirus into the hospital while being seen for an elective surgery.
How Will Doctors Determine Who Gets Surgery and When?
According to Jensen, all of the current guidelines, which have been put forth by numerous medical societies, agree on one basic principle: Delayed surgeries cannot lead to a situation in which the patient will not have as good of an outcome as they would have if they had gotten an operation immediately. Conor Delaney, MD, chairman of the Digestive Disease and Surgery Institute at Cleveland Clinic in Ohio, says that outside of this basic manifesto, each patient’s predicament will largely depend on where they live and how the novel coronavirus moves through the country. RELATED: A Coronavirus Checklist: Prepare for the Possibility You May Get Very Sick “Initially we all thought that there would be a surge of COVID-19 patients for a month. What has become clearer now is that through all of the important social distancing work, the curve has been flattened in many places,” says Dr. Delaney. “What that means is that rather than being overburdened for two weeks or so, hospitals will run at capacity or near capacity for several months.” This is important because the more we are able to spread out the number of people who need medical care for COVID-19, the fewer deaths we will have overall. According to the ACS, a peak in COVID-19 cases is expected to hit some places as late as June. Some patients in need of elective surgery may have to wait until then before they can undergo an operation, but doctors are evaluating every situation individually. Hospitals that aren’t seeing an overwhelming number of COVID-19 patients may still perform elective surgery if there is a risk for infection if surgery is delayed or if the patient is in extreme pain, Delaney explains. “Certainly patients can be debilitated for things like needing a hip replacement, or having difficulty with vision that isn’t going to cause loss of the eye, and these patients often have to wait months to get surgery as it is. We’ve said to these patients that we’re going to delay a bit longer,” says Dr. Cima. The same goes for some heart surgeries. “If someone has a heart attack, you need to take care of that, but if someone needs a valve treatment that they have lived with for several years, that may be able to wait a little longer,” says Jensen.
What Does This Mean for Cancer Patients?
Four of the society’s sub guidelines specifically address cancer care, an experience that is already wracked with uncertainty. According to Jensen, cancer surgeons are still operating more frequently than other types of surgeons at this time. “Cancer is not considered an elective surgery, but there are many types of slow-growing cancers in which delaying surgery will not have an impact on long term results,” says Jensen, noting that often people can live with thyroid cancer for years before getting treatment and have the same outcome as they would have if they had gotten surgery right away. Instead, some doctors may alter the order in which a patient receives multiple treatments, for example, starting someone on chemotherapy or radiation now and getting surgery at a later date, rather than operating first. This is not always the case, and for those who need surgery during the pandemic, these surgeries will still be available. “The most important thing to know is that if you have a cancer diagnosis during the COVID-19 pandemic, you will still be able to receive the care you need to get the best possible outcomes, it just may be modified in certain cases,” says Jensen. RELATED: How Will COVID-19 Impact Cancer Research?
