What is Urgent vs. Elective Surgery? By Vivek P. Kushwaha, M.D. Orthopaedic Surgeon
Recently the Texas Medical Board and Governor Abbott put out a directive ordering the postponement of all elective surgical procedures until after April 21. They did indicate that under the discretion of the surgeon, certain procedures could be performed that were deemed urgent, where significant harm could befall the patient should the procedure be delayed. As one way to define urgency, they gave the example of a procedure that one would not wait to perform for several weeks if encountered in the course of practice.
Obviously this encompasses a gray area that we are all trying to navigate. As a spine surgeon, I treatthe patient with problems in the neck and back. These problems include pain, deformity, numbness,tingling, and weakness. Invasive procedures to treat these conditions include injections, decompressivesurgery, and reconstructive surgery. At this point, I define all injection procedures as elective and non-urgent. As of now, I am not scheduling any injections until after April 21. I also am not scheduling anydeformity and fusion revision surgery until after April 21, unless there is a significant neurologiccomponent to the problems the patient may be having.
Surgical Causes & Treatment
In cases where patients are having numbness, weakness, and loss of function, especially if progressive Ido consider urgent. In these situations, I try to determine if it would be harmful to the patient if severalweeks are allowed to pass before surgical treatment. In those situations where I feel the patient wouldlikely have poorer outcome if surgery were to be delayed, I go ahead and schedule the procedure.One such example was a patient in his 30s with several month history of back and leg pain, however, ithad become significantly worse in the last few weeks. He came to see me with pain, numbness andweakness going into the left leg and calf. He could not stand for more than a few minutes and had apronounced limp when walking. I obtained an MRI, and as I suspected, he had large extruded diskherniation at the L5-S1 level on that left side, causing significant compression of the left S1 nerve root. Iwent over the options with the patient relative to proceeding with urgent surgery or delaying severalweeks. The patient was not only miserable with pain, but concerned about his potential for permanentloss of function of his leg, as well as the more immediate problem of being unable to stand or walkproperly for any length of time. I went ahead and did the surgery a few days later and he hadimmediate relief of symptoms.
Hopefully, the restrictions on elective procedures will be lifted by April 21, or even sooner. Until then weare still evaluating and treating patients, and for the occasional patient that does have an urgentproblem, we are performing surgery as required.
