The COVID-19 pandemic caused millions of elective surgery cancellations nationwide, allowing for a reallocation of resources. Many students are drawn to neurosurgery because even routine procedures can lead to drastic, life-changing effects for patients. Efforts to reallocate resources during the COVID-19 pandemic led to the cancellation and postponement of many elective neurosurgeries nationwide. This raised an important question about what defines an “elective neurosurgical procedure.” The serious nature of neurosurgical procedures, and the ability of clinicians to “schedule” surgeries in advance for these patients, pose an interesting question as to what an “elective” surgery in neurosurgery truly is.
A common elective neurosurgery procedure is tumor resection. Patients with benign tumors, such as meningiomas, must choose whether they want to undergo surgical resection. However, when a 45-year-old female presents with unbearable headaches, progressive personality changes and a head CT revealing a six-centimeter frontal lobe Grade I meningioma, surgery may not be an “elective” undertaking. Although, technically “benign”, the tumor’s mass effect affects the quality of life (QoL). Thus, patients must be operated on to regain their QoL.
Spinal procedures can similarly be elective, sub-acute or emergent undertakings, depending upon the patient’s presentation, neurologic reserve and available medical treatments. As an example, anterior cervical discectomy or fusion, can be the treatment of choice in patients with myelopathy, radiculopathy or myeloradiculopathy. For the patient who has progressive neurologic compromise or who has exhausted medical treatment options, surgical decompression and stabilization may be necessary sooner rather than later.
On my neurosurgical rotation, I encountered a patient with a spinal arteriovenous malformation who was apprehensive about undergoing surgery. The cerebrovascular neurosurgeon encouraged her to have the operation as she would face a high risk of poor outcome without it. Ultimately, the patient consented to the procedure and arrived at the hospital at 6 am. Unfortunately, her case was unexpectedly canceled due to increased case volumes and cancellations of “non-essential” procedures. This patient experienced anxiety related to potential complications followed by disappointment and frustration when their supposed “elective,” but necessary surgery was postponed. This event has further highlighted the importance of providing enhanced emotional support and improved access during such scenarios. We must recognize the psychological impacts of having to undergo life-saving operations and should put greater emphasis on emotional support to deliver optimal care.
The COVID-19 pandemic has led to the cancellation of many elective neurosurgeries, leaving millions of patients in uncertain positions, burdened with the emotional weight of not being able to proceed with life-changing procedures. While such operations are deemed “elective,” they have the potential to drastically improve an individual’s QoL. Thus, clarifying what constitutes an “elective” neurosurgical procedure is necessary. Considering these operations’ immense impact on an individual’s QoL, it is crucial to create better elective procedure guidelines that consider such effects. Further, improved access and emotional support should be provided to ensure the best outcomes possible. The psychological impacts of choosing to undergo life-saving operations should be recognized, and we must move towards more robust guidelines for elective surgery.
