Ethical dilemmas when elective surgery is cancelled
[NEWS, 22 June 2011] Planned operations are sometimes cancelled when the health care system is overwhelmed by emergency cases. Hospitals lose money and efficiency decreases, and patients who have prepared have their surgery cancelled. In an article in the scientific journal Clinical Ethics, researchers at Uppsala University, Karolinska Institutet and the Karolinska University Hospital claim that this has ethical, psychological and medical consequences.
When the first snow falls, Swedish emergency rooms are filled with patients with fractured hips and legs. To deal with these emergency cases, hospitals often have to cancel elective surgery. In an explorative pilot study, the researchers in Stockholm and Uppsala have shown that cancellations of planned elective surgeries lead to medical and psychological problems for the patients, which in turn can be regarded as an ethical dilemma to the health care system.
The study is based on the hypothesis that cancellations are followed by poorer clinical results, mainly on psychological grounds. Postponed hip or knee joint replacement surgeries were compared to a matched set that had not been postponed. The results show that canceled operations result in significantly more complications and a worse quality of life in the long run. Some patients had been notified a few weeks in advance, but the study included some who had found out five minutes before the surgery was to be performed. The most common complications were depression, urinary tract infection, wound infection and myocardial infarction.
Administrative cancellations without medical reasons can make patients feel like victims without control, according to the researchers. The psychological disappointment for a patient who has prepared for elective surgery can cause damage too. This is the first time that consequences of postponed surgery have been analyzed in terms of medical complications and postoperative results. The research group will now go on to conduct a larger prospective study.
Cancellations of elective surgery may cause an inferior postoperative course: the 'Invisible hand' of health care prioritization
Clinical Ethics is published by the British Royal Society of Medicine, United Kingdom.