Can you do elective surgery during the age of Coronavirus? Ah. This is a million dollar question. Of note, this is not talking about doing surgery right now. We are currently shelter in place, and no elective procedures which can be postponed for 30 days are being done. But the ban will eventually lift, likely when we are seeing hospitals emptying, not filling. I expect this won’t be for 6-8 weeks, even longer. But even when the ban lifts, COVID-19 will still be there.
We don’t know the coronavirus COVID -19 well yet. What we do know indicates for the majority of people, particularly those 50 and younger, the risk is low. As time passes, and hopefully there are better treatments, more insights, herd immunity, and a possible vaccine, it should be little different than the flu. And we do surgery all winter through the flu season. Many of you will have had the virus and recovered. For those who have not had the virus yet, read below.
These are just things to think about when trying to stratify your risk. ALL SURGERY HAS RISK. Always. Period. This will be another thing to consider.
- HOW ELECTIVE IS THE SURGERY? There is a different bar for truly elective surgeries (ones that you could postpone for a month with no risk in morbidity or mortality) than for elective surgeries which are more urgent. (Urgent surgeries are things like -Do you have a cancer? is it fast or slow growing? do you have recurrent gallstone attacks which land you in the hospital with pancreatitis?). Most of the surgeries I do are elective. So for those, we have to keep you safe. Please read thoughts below.
- DO YOU HAVE ANY SIGNS OF SICKNESS? Anyone in your family? The most common symptoms of Coronavirus COVID-19 coming on are malaise, muscle aches, dry cough, sore throat, and low grade fever (temp 100 or higher). Symptoms take on average 5 days to present.
- ARE YOU AT HIGH RISK OF EXPOSURE? Do you have a lot of exposure to other people in your job? Do you travel frequently? What is your home situation like? Do you have three kids who love to high five everyone and lick subway poles? Can you sequester yourself from your family?
- WHAT IS YOUR AGE? For sure it is something to consider if you are over the age of 60 given the known mortality rates being higher for older people.
- DO YOU HAVE OTHER MEDICAL ISSUES? Do you have diabetes, heart disease, lung issues, or high blood pressure? Are you a smoker (tobacco or pot)? Vaper? As we know these could put you at higher risk.
- WHERE IS THE SURGERY BEING DONE? Is it at a major hospital or a small surgery center? Here I think surgery centers like the one I use are safer. My center is only for plastic surgery- healthy, outpatient surgeries. Sick patients do not go to our center. Because the center is so small, there is less exposure because not many people work there. Fewer people = better.
Until elective surgeries were suspended, I was urging my patients to self sequester prior to the operation (at home don’t hug your family and avoid the public), be religious about hand washing and hygiene, and to call me if there was any issue, particularly low grade fever or cough.
In some ways a surgical suite is the safest place you could be during an outbreak- it is routinely disinfected and sterilized, everyone is wearing scrubs, gowns, masks, gloves, and hats, and then after surgery we DON’T want you to go out. We want you at home recovering. (Maybe my patients will finally adhere to my recommendations of “taking it easy” after surgery.)
So my overall thoughts?
We will know more as time progresses. We as surgeons are very aware of good infection prevention practices. We have been doing them for years. I truly believe if you are not sick going into surgery, the surgical operating room and recovery isolated in your home is safe. But I listed points to consider above. I do not think Coronavirus is going to “go away.” Many think there may be a waning period during the summer months with resurgence in the fall. Most believe this will eventually become another vaccine we get yearly as we do for influenza.
A main reason elective surgeries were canceled now is not necessarily a risk to the surgery patient- it is to keep those resources open in case surgery centers are needed for overflow critical care patients and resources.
Surgery has risks. This is now another one we will need to discuss at your preoperative visit.