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 technically an “optional” or elective procedure.

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 (CDC), in 2000 over 40 million inpatient surgical procedures were performed in the United States. Ambulatory surgery accounted for 31.5 million procedures in 1996, the most recent year for which CDC data is available. Statistically, women were more likely to have surgery, accounting for 58% of ambulatory and inpatient procedures. This data includes both emergency and elective procedures.

Description

There are literally hundreds of elective surgeries spanning all the systems of the body in modern medical practice. 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 ).
• Exploratory or diagnostic surgery. Surgery to determine the origin and extent of a medical problem, or to biopsy tissue samples.
• Cardiovascular surgery. Non-emergency 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 , bloodwork, and electrocardiogram) are administered as part of the preoperative evaluation.

Other preoperative preparations will be dependent 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, 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

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Elective surgical results depend on the type of procedure performed. Optimal results for an elective procedure should be discussed with the patient 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.

Morbidity and mortality rates

Success, morbidity, and mortality rates are also dependent 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

Cottrell, James, and Stephanie Golden. Under the Mask: A Guide to Feeling Secure and Comfortable During Anesthesia and Surgery. Piscataway, NJ: Rutgers University Press, 2001.

Klippel, John. All You Need to Know About Joint Surgery: Preparing for Surgery and an Active New Lifestyle. Atlanta, GA: The Arthritis Foundation, 2002.

periodicals

O’Conner-Von, Susan. “Preparing Children for Surgery: An Integrative Research Review.” AORN Journal 71, no. 2 (February 2000): 334–4