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Delaying Elective Surgery after Hospital Admission Increases Risk of Infection

Posted Jan 03 2011 12:00am

It's not an uncommon occurrence for a scheduled elective surgery to be delayed because the case gets crowded-out by emergency procedures or unexpected longer cases. This can be uncomfortable for the patient in question who has gotten ready psychologically for the surgery. But what can you do -- just wait your turn? It turns out that there are even more serious consequences of delayed elective surgery on the basis of recent research (see: Delaying elective surgery raises risks, costs: new study ). Below is an excerpt from an item I recently came across:

Delaying elective surgical procedures after a patient has been admitted to the hospital significantly increases the risk of infectious complications and raises hospital costs....The occurrence of infection following surgical procedures continues to be a major source of morbidity and expense despite extensive prevention efforts that have been implemented through educational programs, clinical guidelines, and hospital-based policies. The authors of the study queried a nationwide sample of 163,006 patients, 40 years of age and older, from 2003 to 2007. They evaluated patients who developed postoperative complications following one of three high-volume elective surgical procedures: 87,318 coronary artery bypass graft (CABG) procedures, 46,728 colon resections, and 28,960 lung resections. The infectious complications evaluated included pneumonia, urinary tract infections, postoperative sepsis and surgical site infections. Researchers found that for each type of procedure, infection rates increased significantly from those performed on the day of admission to those performed one, two to five, and six to 10 days later. Total infection rates after CABG increased from 5.7 percent on the day of admission to 18.2 percent at six to 10 days.

A hospital is not a very safe place in which to unnecessarily hang around. There a a lot of nasty "bugs" that thrive in a hospital environment but not, say, in your home. However, what course of action should a patient and his family pursue when "bumped" from the the day's OR schedule. I came across another article in which one of the authors of the study cited above was interviewed at a conference (see: Delayed Elective Surgery Linked to Increased Postoperative Infections ). Here's a quote from this latter article

The data suggest that it would be better to send patients home to await the day of their planned surgery than to keep them in the hospital for a few days until their slot on the schedule opens, [according to Dr. Todd R. Vogel]. Other surgeons at the meeting suggested that another possible explanation is that many of the delayed cases weren’t really elective. “In this day and age, what hospital would admit a patient and then wait until the next day to take out their colon?” asked [another surgeon at the conference]. But Dr. Vogel expressed skepticism that these weren’t virtually all truly elective patients [in the study data]. Hospitals would want to “upcode” cases that were not elective because they would be paid more, he noted.

Here's my take on all of the above. If I or a member of my family encountered a delay of an elective surgical procedure, I would insist that it be performed no later than the next day. If this was not possible, I would ask to be discharged and would return when a definite operating room slot could be guaranteed. I assume here that the procedure was truly elective and only a physician could make such a judgement.

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