Nikki Sommer, a nurse with Key West Surgical Group, joined Good Morning Keys on KeysTalk 96.9/102.5 FM for Medical Matters this morning.
It’s important not to cancel surgical procedures because of the holidays.
Sommer said, “I know this time of year, people schedule their surgery, and then they have second thoughts and they cancel it. There’s many different reasons why people cancel their surgery, and sometimes it’s unavoidable. You can’t help it. There’s an illness related, you had to have pre op testing and there was an abnormal value in something else, another medical condition needs to be addressed first. But when you have elective surgeries like hernias, which are elective, but like we’ve talked about, they can become an emergent situation. When you put off surgery, you potentially end up, the problem worsens over time, and then your recovery is a lot longer.”
You really shouldn’t put off addressing pain in your lower right quadrant, particularly.
Sommer said, “If you have lower right quadrant pain and you still have your appendix, please don’t put that off. Your appendix can rupture, and then that becomes a real big emergency with a lot of IV antibiotics, and bad stuff can happen after, so don’t ignore those warning signs.”
What are some of the reasons people cancel surgery?
Sommer said, “The patient ate breakfast. Because they’re supposed to fast, nothing to eat or drink after midnight. I bring this patient up all the time. He was supposed to be on a clear liquid diet, and he ate pork chops for dinner.”
The second reason is they forgot to prep.
Sommer said, “It kind of coincides with the guy that ate pork chops. But we also have had patients realize the morning of the colonoscopy that they ate the day before, even though, or they did their prep, but they ate solid foods all day long, so that negates.”
Some people also forget to show up.
Sommer said, “That really happened too. I’m not making this up.”
Another reason is people don’t want to wait.
Sommer said, “This has happened so many times. The patient shows up and gets frustrated and leaves because they didn’t want to wait.”
Michael Stapleford of KeysTalk 96.9/102.5FM pointed out, “If you were the one who was being operated upon, you would not want the surgeon to hurry through yours just to get to the next one.”
Sommer said, “We use that as an example all the time, when they get annoyed. Listen, this is surgery. The world of surgery is very complicated and complex. So yes, they have office hours, but they also have to take care of emergencies, and they’re on call and when we have to reschedule their day, and it’s a situation that is beyond their control, people get really angry. There’s somebody on the table right now who could be fighting for their life. It’s not that your problem is not important. It’s just somebody right now needs their attention more than you do.”
Sometimes surgery gets canceled because of abnormal test results.
Sommer said, “That’s something that sometimes can’t be avoided. We do have a lot of patients, primary care down here is some people don’t ever go see a doctor and I know it’s hard to get into our primary care doctors. They’re really booked solid. We need some more primary care doctors. I mean, we have great ones, but sometimes people don’t even seek it out. I don’t need a doctor. I feel healthy. So they come in and they say, I have no health problems. But based on their age, we need to get, over the age of, usually 50, you need labs, a chest X ray and EKG, and something comes back abnormal, and then we need to investigate that further.”
If a patient gets sick, surgery can be canceled.
Sommer said, “Right now, it’s flu season, and COVID is still rearing its ugly head, so sometimes those things do pop up and that’s beyond anybody’s control. That’s more understandable.”
Sometimes surgery is canceled because patients can’t pay.
Sommer said, “That is another big roadblock we face and like when we talked about all the different insurance plans, this goes back to where the patient doesn’t really understand what their out of pocket is going to cost, what their deductible is and then they are pretty healthy, so they’ve never had to use their insurance and it comes that they need surgery, and they find out it’s going to cost them $5,000 or more. That puts a little strain on them financially and they have to wait.”
Transportation can be an issue, too.
Sommer said, “When you have surgery, you cannot drive yourself home. Whether it’s a colonoscopy, an endoscopy, a hernia surgery, you are given medications to sedate you and I can’t tell you how many people come in here and say, I don’t have anybody to give me a ride. They don’t need a ride to there. You can take an Uber, a cab to the hospital, but a lot of the policies, especially the surgery center, you cannot take a cab, an Uber home. They want somebody to physically pick you up, take you home and bring you into your home.”
A schedule conflict can also result in canceled surgeries.
Sommer said, “Work will be a problem. Previous family obligations. They’ll pick a date it’s approaching to the date they call. They need to reschedule. There are certain people that that just they will keep rescheduling.”
Fear or anxiety also makes people cancel surgeries.
Sommer said, “Fear and anxiety over two things, that they’re going to find something wrong. And that is the biggest thing people are afraid. We see this more with colonoscopies than anything else, because it’s screening, and it’s always what if they find something? Well, that’s why it’s done, because the sooner you find something, the easier it is to treat. Polyps don’t usually start out as being cancerous. They grow and turn into cancer. So there’s always that fear and anxiety. Then there’s the fear and anxiety when you’ve had a biopsy and it is cancer, and people just are afraid of what’s going to come after.”
What are some of the complications and ramifications of canceling surgery?
Sommer said, “The next available day might be weeks or even months away, depending on the type of surgery you have, it’s a more involved surgery, like a colon resection or you have a colostomy and we need to put you back together. There’s a lot of work that goes into preparing you for that. So if you just change the date because of a schedule conflict that could prolong it even further. You might end up in the emergency room. A friend of mine just went into the emergency room. This isn’t even surgery related. He was having just like a GI issue, and then they thought his kidneys were failing, and he got a bill for $18,000 from the emergency room.”
Pre-op testing is only good for a certain period of time.
Sommer said, “30 days. So if you are required, like, sometimes we need more than just testing. We need, like, a clearance by your regular doctor or a cardiologist when an anesthesiologist is responsible for putting you to sleep. So they need that within 30 days. So if you had to have that, you may need to repeat that again, which again, is going to incur more cost to you for the testing and to see the specialist or your doctor again.”
Putting surgery off can also affect other people.
Sommer said, “There are a lot of people that want to have the surgery and if the doctors are like, I want to have it tomorrow, well, we’re three weeks out and then in that three weeks, people start canceling at the last minute, trying to get somebody else to fill that spot, because they’re trying to plan their life. You’re putting somebody else out of the spot for surgery.”
The NIH said that 83% of canceled surgeries could have been avoided.
Sommer said, “So I wanted this for comparison. In 2009 Tulane did a study and canceled surgery cost hospitals $1.5 million in lost revenue. In 2021, the University of Pennsylvania published a study where it said between 2016 and 2017 hospitals lost $22.3 billion nationally from canceled surgeries. So when people complain about the cost of health care, this is a contributing factor. Just keep that in the back of your mind.”