Deciding to have surgery is never easy. But early this year, after months of back pain and increasing disability, Ned Garrison (not his real name), a lawyer in northern California, had finally made up his mind to undergo the lumbar fusion procedure his doctor recommended. “Everything was arranged,” Garrison remembers. Then the coronavirus began to spread. A day before the operation was scheduled, last March, Garrison was told it was canceled. The University of California, San Francisco Medical Center, following government recommendations, was forced to halt all nonemergency surgeries, including Garrison’s.
“I’d been following the news closely, but it still came as a shock,” says Garrison. “I was in a lot of pain from a badly deteriorated disk. And though I completely understood why the surgery was canceled, I was left not knowing when it would be rescheduled.”
Garrison wasn’t alone. Patients across the country had elective surgeries put on hold—in part to make sure medical equipment and protective gear were available for treating Covid-19 patients, and in part to protect patients who didn’t absolutely need treatment from being infected with the virus while in the hospital. Now, as many parts of the United States are reopening, medical centers are resuming nonessential and elective surgeries. But with the threat of Covid-19 still present, health experts have made changes in how patients are screened and how elective surgeries are handled.
A decision with moving parts
There’s no single or simple answer. Many factors go into making the decision, from the surgery’s nature and urgency to the status of the pandemic in your area.
To help guide doctors and medical facilities during this period, the American College of Surgeons, the American Society of Anesthesiologists, and several other professional organizations have created a road map for safely resuming elective surgeries. Among the recommendations:
- The spread of Covid-19 in the area should be under control. Specifically, the rate of new infections should be declining for at least 14 days before hospitals resume elective surgeries.
- Medical facilities should have enough excess capacity to care for Covid-19 patients if a spike in new infections occurs.
- Hospitals and surgery centers must have a reliable supply of personal protective equipment on hand for medical staff.
- Covid-19 tests should be available so patients can be tested before surgery.
- Medical centers should follow preventive measures such as social distancing and the use of facemasks.
- During surgery and post-op, non-Covid-19 patients should remain in an area of the facility separate from Covid-19 patients.
Your decision to reschedule elective surgery depends on such factors as the procedure’s urgency and your current health. The first step is to contact your doctor to discuss the benefits and risks—which include the chance of coronavirus infection—and then create a plan. With a backlog of elective procedures and the challenges that medical facilities face in reopening, don’t be surprised if you have to wait for some time before your surgery can be scheduled.
If you decide to proceed with surgery, you’ll need a pre-op assessment. The Centers for Medicare and Medicaid Services requires a recent history and physical examination within 30 days of surgery to make sure your health status hasn’t changed significantly. You may need to have blood tests or other tests redone. Some pre-op might be done remotely via telehealth methods. Other components of the assessment could be scheduled for the same day of surgery.
It’s also important to talk over what your recovery will involve. Whenever possible, patients will be encouraged to recover at home, since there’s a high risk of coronavirus transmission in the hospital, rehab centers, and nursing homes.
In the Covid-19 era, the experience of undergoing elective surgery has changed dramatically, as Ned Garrison learned firsthand. Almost two months after his back surgery was postponed, his operation was rescheduled.
On the day of surgery, his wife had to drop him off at the curb—with few exceptions, family and friends weren’t allowed in the medical center. “As soon as I arrived, I was given a mask and had my temperature taken,” Garrison recalls. “Everyone, from the admission clerk on, was wearing masks. And when I wasn’t being personally directed by someone, signs on the floor indicated exactly how I was supposed to walk and where I had to stand to wait.”
As the country reopens, and medical centers resume elective surgeries and other procedures, health care experts are hopeful that enhanced viral testing, augmented disinfection procedures, and other measures will keep patients safe. The decision to reschedule elective surgery is still a serious one that you and your doctor should discuss together. But much of the fear and uncertainty that prevailed when the pandemic first began to spread have been eased.
As for Ned Garrison, his lumbar fusion went well, and he is currently recovering at home. “I’m glad the surgery was postponed,” he says, “and just as glad I was able to finally have it done.”
This article first appeared in the August 2020 issue of UC Berkeley Health After 50.