Opinion: Don’t delay surgical treatment due to fear of hospital exposure 

 

Delaying surgical care can be risky and if you’re considering it, discuss it with your doctors. Keep in mind, hospitals have pandemic protocols in place to prevent transmission.   

Dr. Alysandra Lal

Operating rooms in Milwaukee are now back to full capacity because we have available hospital beds, adequate personal protective equipment and we have testing that allows us to screen patients for COVID-19 prior to surgery. A few months ago, our recovery room had been converted into an ICU, testing was not as available and took much longer, and we were concerned about running out of ventilators, sedation medications and PPE. Hopefully, we will never return to those times even if there is another surge in COVID-19 cases.   

What I learned as a surgeon during the peak of the crisis, and now in our current smoldering state, is that some care can be postponed in close collaboration between patients and providers. However, it was also frighteningly clear that patients should not delay seeking emergency medical care. Based on all our virus transmission metrics, operating rooms are a safe environment to receive care. Above all, I am reminded that science is not political, and politics should not get in the way of following the best practices supported by scientific data. 

Don’t delay surgical treatment due to fear of hospital exposure. We always offered emergency surgical procedures even during the peak of the crisis, but patients were reticent to come to the hospital due to fear of exposure. As a result, during the peak of COVID-19 infections we operated on patients who were much sicker and who had more advanced disease. In surgery, there were more cases of perforated appendicitis, very severe cholecystitis, perforated ulcers, and so forth, than we had seen in decades. Patients with strokes or heart attacks, for whom timely care is critical, presented too late or likely died at home from conditions that could have been treatable had they sought timely medical care.   

In Milwaukee, we are currently in a safe period for surgery. Routine pre-operative testing of asymptomatic surgical patients is being uniformly performed. Only a very small percentage of people who are tested preoperatively are positive for COVID-19. We have protocols for operating on patients who need surgery despite being positive for the virus with designated operating rooms and strict cleaning protocols. The work that brought us to this safe place will also help us to avoid another complete shutdown of surgery if and when cases increase again. 

During the pandemic, we saw heartbreaking scenes of patients isolated from their families and healthcare providers grappling with lack of resources. But we also saw selfless acts by patients, families and medical professionals, as well as those in other service sectors. Medicine gives providers a unique insight into human behavior and it is the many acts of love and kindness we witness that make the difficult situations bearable.  

I have patients from all walks of life, all political and socioeconomic groups, but in medicine and surgery, we treat everyone equally. Science, like medicine, is not political. Although the scientific process is not perfect, it should be unbiased. With pressure to come up with information, treatments and preventative measures at an impossible speed, science will certainly get some things wrong. In the meantime, I ask my community to follow what we currently think are the best practices.  For now, that includes mask wearing, social distancing, COVID-19 testing and a willingness to take a vaccine when one is available. Those recommendations may change but we hope you will continue to trust that we are doing our best and participate in these important public health recommendations. 

Hospitals are opening in a safe, methodical fashion to allow resumption of surgery. With cases in the hospital at a low point and protocols in place to prevent transmission, now is a safe time to have surgery. The risks of delaying surgical care for some patients will outweigh the risks of infections, so we encourage patients to come to the emergency department, urgent care and primary care offices as needed.  

Finally, while the messaging about the virus has been frustrating, please continue to work together as a community to follow best practices to reduce transmission and get us all back to work and school.  

Dr. Alysandra Lal is chief of surgery at Ascension Columbia St. Mary’s Hospital, Milwaukee, a clinical professor of surgery at the Medical College of Wisconsin and practices as part of Madison Medical Affiliates Surgery. She holds a Master of Public Health from John’s Hopkins University. She is also a member of Congregation Sinai with her husband, Dave Lal, and their two sons, Aidan and Layton.