An Overview of Elective and Nonelective Surgeries

Introduction

The spread of the novel coronavirus led to the halt of elective procedures, which impacted most aesthetic surgeries and hugely impacted the socioeconomic status of most private clinics. Now, these elective procedures are resumed across many countries. Cases that could worsen the condition required emergency treatment and were categorized into nonelective surgeries. The cases where the condition was not likely to worsen were categorized into elective procedures. Elective procedures included cosmetic surgeries such as removing moles or warts, tonsillectomy, adenoidectomy, cleft lip repair, ear tube surgery, bariatric surgery, hernia repair surgery, orchidopexy, eye surgery for strabismus, and spinal fusion surgery. Nonelective surgical procedures included acute appendicitis, trauma, cancer emergency symptoms such as neutropenic fever, arrhythmia, deep vein thrombosis, or hemorrhagic cystitis, neurosurgery, organ transplants, cardiac emergencies, removal of the gallbladder, amputation, perforated ulcers, and intestinal obstruction.

What Is Elective Surgery?

Elective surgery is a procedure that doctors can schedule in advance. They are not emergency procedures but require medical attention and can be delayed for some days. They include cosmetic procedures like removing a wart or mole or a serious condition like surgery for a hernia, kidney stone removal, or hip replacement.

What Are the Benefits of Elective Surgery?

The benefits of elective surgery are:

• Patients are provided days or weeks before the procedure to improve their health, including losing weight, consuming healthy foods, and reducing smoking or exercising.

• The patient will have time to be prepared for the surgery.

• By reducing risk factors such as smoking or diabetes, patients can achieve successful surgical treatment through improved wound healing.

• The patient will get to know in detail about the procedure.

• Informed consent is given to the patient.

What Are the Common Elective Surgical Procedures?

The common elective procedures are:

• Cosmetic surgeries such as removing moles or warts.

• Tonsillectomies (surgical removal of the tonsil) or adenoidectomy (removal of adenoid glands) to treat obstructive sleep apnea.

• Cleft lip repair.

• Ear tube surgery.

• Bariatric surgery (involving changes in the digestive system to reduce weight).

• Hernia repair surgery (a surgical procedure, where the weakened abdominal muscle is repaired, and holes are closed).

• Orchidopexy (surgical procedure for undescended testicles).

• Eye surgery for strabismus (eyes are not lined up properly) or cataracts (lens of the eye becomes cloudy, which causes difficulty in vision).

• Spinal fusion surgery for scoliosis.

• Surgery for sports injuries.

• Carpal tunnel surgery (an incision made on the palm to relieve pressure on the median nerve).

• Esophagogastroduodenoscopy (EGD or upper endoscopy), colonoscopy and endoscopies.

• Low-risk cancer.

• Hip or knee replacement.

• Elective angioplasty (a surgery done to relieve pain and shortness of breath due to obstruction in the arteries).

What Does an Informed Consent for Elective Procedures Contain?

The informed consent for elective procedures includes:

1. The medical staff should obtain suitable qualifications to obtain a consent form.

2. Medical staff should use an appropriate consent form, such as:

• Consent for patients above eighteen years; they must comprehend and retain information to be legally competent.

• Consent for patients below eighteen years should be sought from a parent.

• Consent is given to patients not requiring anesthesia when no consciousness is impaired, or anesthesia is given, which is done for a limited elective procedure.

3. Medical staff can use other media to explain the procedure in detail, including audio-visual information, leaflets, or verbal consent.

4. The informed letter should be given during pre-assessment or on the day of surgery.

5. The doctors should explain all the procedures, including anesthetic details, and also clear their doubts before surgery. The explanation of the procedure should include the following:

• The risks and benefits of the procedure. The doctors should warn the patient about adverse effects. Doctors should explain the risks clearly, and with the truth; after explaining the complications that could occur after the treatment, it is sensible to explain the benefits to patients. Everything is explained clearly so that the patient can make a balanced decision.

• Alternative treatments. Based on the advantages and disadvantages of the current treatment, doctors should explain alternative procedures to the patient.

• Complications that could occur if the procedure is not done. Long-term possibility and ill effects of the condition should be highlighted.

6. Medical staff should avoid medical jargon (medical terms).

7. The decision should be timely if the patient requires more time to think.

What Is Nonelective Surgery?

Nonelective surgeries are done immediately; they require immediate attention because of life-threatening conditions such as serious injury from accidents, acute appendicitis, or testicular torsion. Therefore, treatment should be done within a short frame of time.

What Are the Nonelective Procedures?

The nonelective procedures include:

• Acute appendicitis.

• Trauma.

• Cancer emergency symptoms such as neutropenic fever (increased neutrophil count with a temperature greater than 101 degrees Fahrenheit), arrhythmia (irregular heartbeat), deep vein thrombosis (blood clot in the veins of the leg), or hemorrhagic cystitis (inflammatory condition of bladder along with bleeding from the bladder mucosa).

• Neurosurgery.

• Highly symptomatic patients.

• Transplants of the organ.

• Cardiac emergencies.

• Limb-threatening vascular surgery.

• Removal of the gallbladder.

• Amputation.

• Perforated ulcers.

• Control of bleeding.

• Intestinal obstruction.

How Are Elective and Nonelective Surgeries Assessed?

A doctor assesses elective or nonelective procedures, depending on the medical need. The patients are classified into three categories for surgery:

• Category 1 - Urgent Surgeries: This includes cases where the condition can worsen quickly to a point where it can become an emergency. Surgeries are planned immediately for these cases, such as cardiac emergencies such as heart attacks or shocks, physical trauma, neuro surgeries, appendicitis, organ transplants, and perforated ulcers.

• Category 2 - Semi-urgent Surgeries: This includes cases where the symptoms are likely to deteriorate to a point where it can become an emergency, such as arthroscopy for a locked knee, tuberculosis spine for debridement and stabilization, etc.

• Category 3 - Non-urgent Surgeries: This includes cases where the symptoms do not deteriorate quickly to a point where they can become an emergency, such as joint replacement surgeries and cosmetic surgeries.

Conclusion:

Due to the pandemic, elective procedures were put on hold or planned, where patients did not require emergency treatment for some conditions. Delaying elective surgeries has no ill effects. However, nonelective procedures or emergencies had to be treated right away by health professionals.