The Consequences of Delaying Elective Surgery: Surgical Perspective

Fu, Sue; George, Elizabeth; Maggio, Paul M.; Hawn, Mary T.; Nazerali, Rahim

doi:10.1097/sla.0000000000003998

Cited by 116 publications

(116 citation statements)

References 5 publications

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“…Gallstone-related acute pancreatitis – which has an annual incidence ranging from 15 to 40/100,000 across different Countries [ 10 , 11 ] – could potentially be a life-threatening complication, requiring urgent endoscopic or surgical intervention. Additionally, a more advanced disease at the time of surgery may result in increasingly morbid operations, which are associated with prolonged hospital stay and higher costs [ 4 ]. Since the global healthcare community has never faced a dramatic scenario such as the COVID-19 pandemic, it is difficult to forecast the effects of untreated GD and the development of its related complications during and after COVID-19.…”

Section: Discussionmentioning

confidence: 99%

“…To maintain the ability of hospitals to treat a large influx of potential COVID-19 patients, elective surgical activities addressing benign diseases have been suspended or limited [ 3 ]. However, elective surgery is not optional: indeed, being “presently non-urgent” does not mean being “unnecessary” [ 4 ]. Moreover, benign diseases scheduled for elective surgery may eventually lead to severe morbidity, which cannot always be harmlessly postponed.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Global management of a common, underrated surgical task during the COVID-19 pandemic: Gallstone disease - An international survery

Manzia¹,

Angelico²,

Parente³

et al. 2020

Annals of Medicine and Surgery

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Background Since the Coronavirus disease-19(COVID-19) pandemic, the healthcare systems are reallocating their medical resources, with consequent narrowed access to elective surgery for benign conditions such as gallstone disease(GD). This survey represents an overview of the current policies regarding the surgical management of patients with GD during the COVID-19 pandemic. Methods A Web-based survey was conducted among 36 Hepato-Prancreato-Biliary surgeons from 14 Countries. Through a 17-item questionnaire, participants were asked about the local management of patients with GD since the start of the COVID-19 pandemic. Results The majority (n = 26,72.2%) of surgeons reported an alarming decrease in the cholecystectomy rate for GD since the start of the pandemic, regardless of the Country: 19(52.7%) didn't operate any GD, 7(19.4%) reduced their surgical activity by 50–75%, 10(27.8%) by 25–50%, 1(2.8%) maintained regular activity. Currently, only patients with GD complications are operated. Thirty-two (88.9%) participants expect these changes to last for at least 3 months. In 15(41.6%) Centers, patients are currently being screened for SARS-CoV-2 infection before cholecystectomy [in 10(27.8%) Centers only in the presence of suspected infection, in 5(13.9%) routinely]. The majority of surgeons (n = 29,80.6%) have adopted a laparoscopic approach as standard surgery, 5(13.9%) perform open cholecystectomy in patients with known/suspected SARS-CoV-2 infection, and 2(5.6%) in all patients. Conclusion In the ongoing COVID-19 emergency, the surgical treatment of GD is postponed, resulting in a huge number of untreated patients who could develop severe morbidity. Updated guidelines and dedicated pathways for patients with benign disease awaiting elective surgery are mandatory to prevent further aggravation of the overloaded healthcare systems.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Global management of a common, underrated surgical task during the COVID-19 pandemic: Gallstone disease - An international survery

Manzia¹,

Angelico²,

Parente³

et al. 2020

Annals of Medicine and Surgery

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“…Sell et al see the risk for impaired surgical education with long-time consequences for the surgical workforce as well in the realm of COVID-19 [13] . Fu et al summarized the multidimensional indirect consequences of COVID-19 on surgery including a relevant backlog of elective operations, disease progression in consequences of delayed care, impaired surgical educations due to cancelled scholarships and lectures as well as economic losses from postponed surgery [14] . Globally, more than 28 million operations were estimated to be cancelled or postponed during the 3 month enduring peak of COVID-19 requiring 45 weeks to compensate the loss provided that post-pandemic surgical rate was increased by 20 per cent [15] .…”

Section: Discussionmentioning

confidence: 99%

Elective surgery in times of COVID-19: A two-centre analysis of postponed operations and disease-related morbidity and mortality

Metelmann

Busemann

2020

Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheit

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Introduction: COVID-19 had an impact on the whole range of worldwide medical services. Due to the high risk of in-hospital transmission and disproportionate perioperative rates of morbidity and mortality in occult COVID-19 patients surgeons were faced with the challenging triage of surgeries into emergency, urgent and elective. The present study investigates postponed elective surgery and its impact on the medical condition of patients in two high-volume departments of general, visceral, thoracic, transplant and vascular surgery. Methods: Operations that have been postponed due to COVID-19 were recorded in the Departments of General-, Visceral-, Thoracic-and Vascular Surgery at the University Hospitals of Leipzig and Greifswald. Data was analysed descriptively concerning patient outcomes as well as emergency admissions and surgeries. Results: In the Leipzig and Greifswald University Hospitals 89 and 92 elective surgeries were postponed, respectively. No patient needed an extension of surgical procedure when eventually operated. One patient with extensive obesity died early during the suspension period due to cardiac complications. Four patients needed emergency admission to hospital one of whom required urgent surgery. In neither of the two surgical departments did a patient acquire a nosocomial infection with COVID-19. Discussion: While medical consequences of COVID-19 seem multidimensional and severe, our data indicate that the short-term postponement of elective surgery did not cause an unproportional increase of morbidity and mortality. Although the restrictions may have been fear-driven, given no confirmed cases and thus no concrete risk of infection, the early and well-coordinated action may have provided protection from uncontrolled interruption of medical services by loss of medical workforce or capacity. Conclusion: Well-organized and early suspension of elective surgery had no disproportionate impact on patient outcomes while averting nosocomial transmission of COVID-19.

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“…Another effective strategy is to call for an urgent cardiac consult when the patient's functional status is reassuring, to allow the possibility of continuing with the surgery. Immediately deciding to postpone a surgery can be unnecessary and cause real impacts on patient health outcomes, hospital finances, and resources [9]. In addition to the emotional and financial burden of the surgical delay to the patient, surgeons can be faced with backlogs of patients that can present with more severe cases in the end.…”

Section: Discussionmentioning

confidence: 99%

Elective Inguinal Hernia Surgery in the Setting of Unfollowed Congenital Complete Heart Block With No Postponement

Varkoly

Beladi

Ritrosky

2020

Cureus

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Most preoperatively discovered complete heart block cases without cardiac clearance in a non-emergent situation are managed with deferral of elective surgery until a cardiology workup can be completed. The medical consequences of surgical delays can manifest in increased costs to the healthcare system via the treatment of more advanced disease, often requiring more intense and more costly treatment in addition to the emotional burden of delay on a patient that has been waiting months for a particular surgery. Delays in surgery have real impacts on patient health outcomes, hospital finances, and patient satisfaction. We present a rare case in which a proactive anesthesiologist was able to take measures to stratify patient safety risk and safely prevent the delay of the surgery in an asymptomatic and unfollowed congenital thirddegree heart block patient. The anesthesiologist demonstrates the use of established guidelines for nonelective noncardiac surgery to safely and effectively prevent the delay of an elective inguinal hernia repair in the setting of a situation that normally warrants its delay. Using these pre-and intraoperative measures, the anesthesiologist was able to prevent the delay of elective surgery, and this should set a precedent of the necessary steps involved to safely manage a patient with an unfollowed third-degree congenital heart block.

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The Consequences of Delaying Elective Surgery: Surgical Perspective

Cited by 116 publications

References 5 publications

Global management of a common, underrated surgical task during the COVID-19 pandemic: Gallstone disease - An international survery

Global management of a common, underrated surgical task during the COVID-19 pandemic: Gallstone disease - An international survery

Elective surgery in times of COVID-19: A two-centre analysis of postponed operations and disease-related morbidity and mortality

Elective Inguinal Hernia Surgery in the Setting of Unfollowed Congenital Complete Heart Block With No Postponement

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