What is Urgent vs. Elective Surgery?

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 treat
the 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, decompressive
surgery, 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 any
deformity and fusion revision surgery until after April 21, unless there is a significant neurologic
component to the problems the patient may be having.

In cases where patients are having numbness, weakness, and loss of function, especially if progressive I
do consider urgent. In these situations, I try to determine if it would be harmful to the patient if several
weeks are allowed to pass before surgical treatment. In those situations where I feel the patient would
likely 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, it
had become significantly worse in the last few weeks. He came to see me with pain, numbness and
weakness going into the left leg and calf. He could not stand for more than a few minutes and had a
pronounced limp when walking. I obtained an MRI, and as I suspected, he had large extruded disk
herniation at the L5-S1 level on that left side, causing significant compression of the left S1 nerve root. I
went over the options with the patient relative to proceeding with urgent surgery or delaying several
weeks. The patient was not only miserable with pain, but concerned about his potential for permanent
loss of function of his leg, as well as the more immediate problem of being unable to stand or walk
properly for any length of time. I went ahead and did the surgery a few days later and he had
immediate relief of symptoms.

Hopefully, the restrictions on elective procedures will be lifted by April 21, or even sooner. Until then we
are still evaluating and treating patients, and for the occasional patient that does have an urgent
problem, we are performing surgery as required.

Author: Orthopaedic Associates

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