Elective Surgery

Definition
Purpose
Demographics
Description
Diagnosis/Preparation
Aftercare
Risks
Normal results
Morbidity and mortality rates
Alternatives

Definition

An elective surgery is a planned, non-emergency surgical procedure. It may be either medically required (e.g., cataract surgery), or optional (e.g., breast augmentation or implant) surgery.

Purpose

Elective surgeries may extend life or improve the quality of life physically and/or psychologically. Cosmetic and reconstructive procedures, such as a facelift (rhytidectomy), tummy tuck (abdominoplasty ), or nose surgery (rhinoplasty ), may not be medically indicated, but they may benefit the patient in terms of raising self-esteem. Other procedures, such as cataract surgery, improve functional quality of life even though they are not medically necessary.

Some elective procedures are necessary to prolong life, such as an angioplasty. However, unlike emergency surgery (e.g., appendectomy ), which must be performed immediately, a required elective procedure can be scheduled at the patient’s and surgeon’s convenience.

Demographics

According to the National Center for Health Statistics of the U.S. Centers for Disease Control and Prevention (CDC), in 2005 over 44 million inpatient surgical procedures were performed in the United States. Heart disease and delivery surgeries were the most frequently performed types of surgery. Statistically, women were more likely to have surgery, accounting for 59% of inpatient procedures. This data includes both emergency and elective procedures.

Description

There are hundreds of elective surgeries in modern medical practice, spanning all the systems of the body. Several major categories of common elective procedures include:

• Plastic surgery. Cosmetic or reconstructive surgery that improves appearance and, in some cases, physical function.
• Refractive surgery. Laser surgery for vision correction.
• Gynecological surgery. Either medically necessary or optional surgery (e.g., hysterectomy, tubal ligation).

KEY TERMS

ACL reconstruction— Repairing a tear of the anterior cruciate ligament (ACL) of the knee using arthroscopy and/or open surgery.

Anaphylactic shock— A potentially fatal allergic reaction to a substance that causes a severe drop in blood pressure, swelling of the respiratory tract with associated breathing problems, rash, and possible convulsions.

Bariatric surgery— Weight loss surgery, such as gastric bypass.

Hemorrhage— Major, abnormal blood loss either from a surface wound or from internal trauma.

Tubal ligation— A surgical sterilization procedure that involves ligating, or blocking and/or tying, the fallopian tubes so eggs can no longer descend from the ovaries to the uterus. Also referred to as getting one’s tubes tied.

• Exploratory or diagnostic surgery. Surgery to determine the origin and extent of a medical problem, or to biopsy tissue samples.
• Cardiovascular surgery. Nonemergency procedures to improve blood flow or heart function, such as angioplasty or the implantation of a pacemaker.
• Musculoskeletal system surgery. Orthopedic surgical procedures, such as hip replacement and ACL reconstruction.

Diagnosis/Preparation

In some cases, insurance companies may require a second opinion before approving payment on elective surgical procedures. Anyone considering an elective surgery should review their coverage requirements with their health insurance carrier before scheduling the procedure.

Diagnostic and/or radiological testing may be performed to confirm the diagnosis or assist the surgeon in planning the surgical procedure. Typically, a complete medical history, physical examination, and laboratory tests (e.g., urinalysis, chest x ray, blood work, and electrocardiogram ) are administered as part of the preoperative evaluation.

Other preoperative preparations will depend on the surgery itself. If a general anesthetic is to be used, dietary restrictions may be placed on the patient prior to the operation. If blood loss is expected during the procedure,

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

An elective surgical procedure is typically performed by a surgeon or qualified physician in either an inpatient, hospital environment or an outpatient, ambulatory center. Some simple, minimally invasive procedures may be performed in a doctor’s office. The type of elective surgery will mandate the qualifications and background of the surgeon or physician who performs it. For example, the removal of a mole or a skin biopsy may be performed in a doctor’s office by a dermatologist, while gastric bypass surgery is performed in a hospital setting by a bariatric surgeon.

advance banking of blood by the patient (known as autologous donation) may be recommended.

Aftercare

Recovery time and postoperative care will vary by the elective procedure performed. Patients should receive complete, written postoperative care instructions prior to returning home after surgery, and these instructions should be explained completely to them by the physician or nursing staff.

Risks

The risks for an elective surgery will vary by the type of procedure performed. In general, by their invasive nature most surgeries carry a risk of infection, hemorrhage, and circulatory problems such as shock or thrombosis (clotting within the circulatory system). The anesthesia used may also present certain risks for complications such as anaphylactic shock (an allergic reaction).

Normal results

Elective surgical results depend on the type of procedure performed. Optimal results for an elective procedure should be discussed with the patient’s health care team prior to surgery. In some cases, the “normal” results from a surgery may only be temporary (i.e., follow-up surgery may be required at a later date), while other results are life long. For example, a facelift may eventually require a second procedure as a patient ages, whereas a tubal ligation offers permanent results.

QUESTIONS TO ASK THE DOCTOR

• What type of anesthesia will be used for this procedure?
• What will my recovery time be?
• What postoperative restrictions will I face after surgery?
• Can the surgery be done as an outpatient procedure?
• How long can I safely wait to have the surgery?
• How many procedures of this nature have you performed? What is your success rate?
• What are the costs involved with both the surgery and necessary postoperative care?

Morbidity and mortality rates

Success, morbidity, and mortality rates also depend on the elective procedure itself. A physician and/or surgeon should be able to provide a patient with statistical information on success rates for a specific elective surgery.

Alternatives

The alternatives available for a particular surgery will depend on the purpose of the procedure. For example, other birth control options would be an alternative to any elective surgery for the purpose of sterilization (i.e., tubal ligation, vasectomy, hysterectomy ). Other elective surgeries may not have a treatment alternative other than foregoing the surgery and living with the medical consequences. As part of informed consent, a patient’s physician should review all possible treatment options, surgical and otherwise, before scheduling elective surgery.

Resources

BOOKS

Morrey, Bernard F., ed. Joint Replacement Arthroplasty, 3rd Edition. New York: Churchill Livingstone, 2003.

Thorne, Charles H., et al., eds. Grabb and Smith’s Plastic Surgery, 6th Edition. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2007.

PERIODICALS

Wright, Charles J., G. Keith Chambers, and Yoel Robens-Paradise. “Evaluation of Indications for and Outcomes of Elective Surgery.” CMAJ (September 2002): 167–72.

ORGANIZATIONS

American College of Surgeons. 633 N. St. Clair Drive, Chicago, IL 60611. 1-312-202-5001. Email: postmaster@-facs.org. http://www.facs.org (accessed March 19, 2008).

Paula Ford-Martin

Robert Bockstiegel