April 3, 2020

'It's kind of devastating': When elective surgeries are canceled, patients may face pain and uncertainty

Daily Briefing

    Hospitals across the country are canceling elective surgeries to increase capacity for Covid-19 patients, leaving some patients concerned that their health conditions, if left unattended, could become "ticking time bomb[s]," The Atlantic reports.

    Canceling elective surgeries? These 5 factors can help you estimate the revenue loss.

    Hospitals cancel elective surgeries per federal guidance

    As cases of Covid-19 increase in the United States, U.S. hospitals—especially those at the center of outbreaks—are running out of staff, equipment, and beds to treat the influx of patients with the disease.

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    In response to that concern, CDC is recommending that hospitals in counties that are experiencing a high volume of Covid-19 cases—such as counties in California and Washington, as well as New Rochelle, New York—cancel and reschedule all non-urgent procedures as needed.

    According to Politico, hospitals in more than two dozen states have followed the recommendation, canceling elective surgeries such as joint replacements, epilepsy procedures, and cataracts surgeries.  

    Patients struggle as elective surgeries are canceled around the country

    But for some patients who considered their procedures essential, the cancelations are unexpected, The Atlantic reports.

    For example, Gary Sloane Jr., 45, was planning to have surgery for a massive hernia caused by a liver transplant on April 22, 2020. But the procedure was ultimately canceled due to the Covid-19 outbreak.

    "If you could see a picture of this hernia, it goes from my where my ribs are and hangs completely down," Sloane said. "You can touch my belly and feel my intestines on the inside. It's horrible."

    Sloane said his surgery has not been rescheduled yet, and while he understands why it was canceled, his health condition is uncomfortable and makes it difficult for him to work. 

    "To have that taken away from you, it's kind of devastating," he said. "I just want it done. …I've been waiting for over a year."

    For Sherrie Kumm, a 33-year-old from Washington, her epilepsy procedure would have prevented her from having a petit-mal seizure almost every day. For the last six months, she prepared for the two-part brain surgery which would require her to stay in the hospital for up to a month. She'd even packed a suitcase for her hospital stay.

    But on Friday, her doctor postponed the appointment, and so far she has been unable to reschedule. "I had been mentally preparing and physically preparing myself and my children for six months," Kumm said.

    When Robert Cruickshank went to an ED in Seattle with bad stomach pains three weeks ago, he was diagnosed with gallstones and told to come back for surgery "as soon as possible," The Atlantic reports. On Friday, his gallbladder-removal surgery was postponed indefinitely.

    Now, he's worried that he'll have another bout of pain that will send him to the ED. "If I go to the [ED], are they going to have to turn me away and say, 'Sorry, we have a bunch of coronavirus patients?'"

    Hospital left to grapple with touch decision

    While most providers agree that canceling elective appointments was the right decision, a lot of hospitals are struggling to balance the new guidelines with prioritizing their patients' health and their hospital's bottom line.

    "It's not like there's always a crystal-clear line between elective and emergency [procedures]," said Will Schlotter, CEO of Capitol Anesthesiology Association in Texas. "It is a complex situation."

    For instance, hospitals have largely been left to make the difficult decision of which procedures qualify as "elective." Andrew Ko, Kumm's neurosurgeon at the University of Washington, said the hospital administration is prioritizing surgeries that affect patients' length of life—meaning that surgeries aimed at improving "quality of life," such as procedures for for conditions like Kumm's and for slow-growing brain tumors, have been postponed.

    David Battinelli, CMO of Northwell Health in New York, which has about 2,500 Covid-19 patients, said the health system is currently reassessing which of the delayed elective procedures can be rescheduled and how soon. "When you say elective, a person on the street might think, well, maybe they didn't need it at all," he said. "Some of these planned procedures can't be put off that long."

    David Hoyt, the executive director of the American College of Surgeons said that sooner than later, a lot of the procedures that are considered nonurgent will become urgent, meaning hospitals may have a backlog of postponed surgeries to fill within a few months.

    "This is going to be a big story as places are peaking and then trying to take care of the backlog," Battinelli said. "We really do believe we're going to be dealing with the tail end of this for many months" (Rayasam, et al., Politico, 3/29; Zhang, The Atlantic, 3/17; Hughes, USA Today, 4/1).

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