Essential Surgery

Essential surgery is an operative procedure that is considered to be vitally necessary for treating a disease or injury. Postponing or deciding against an essential procedure may result in a patient's death or permanent impairment.

Description

Essential surgery may be performed on either an elective or emergency basis. Elective surgery is defined as surgery that can be scheduled in advance and is not considered an emergency. Some elective surgeries, however, may be considered essential. For example, an aortic aneurysm is a weak spot in the wall of the aorta, a major blood vessel. If an aortic aneurysm is found during a physical examination or imaging procedure, an aneurysmectomy (surgical repair of an aneurysm) may be scheduled as an elective procedure. In most cases, complications can be avoided if the aneurysm is repaired in a timely manner. If no repair is performed, however, the aneurysm may grow larger and eventually burst; this serious medical emergency is most often fatal.

In other cases, essential surgery arises out of a medical emergency, giving the patient and physician less time to prepare for surgery or seek alternatives. An example of such an emergency is appendicitis, or an infection of the appendix (a pouch-shaped organ in the abdomen). If left untreated, appendicitis may result in a ruptured appendix, which is a life-threatening condition. An appendectomy (surgical removal of the appendix) is usually considered essential in treating appendicitis and avoiding rupture. Another example is trauma surgery, or surgery to repair serious injuries to the body.

A surgical procedure may be optional under some circumstances and essential under others. An example is surgery for Crohn's disease, or chronic inflammation of the intestines. This condition is associated with such symptoms as abdominal pain, fatigue, fever, loss of appetite, and weight loss. Patients who are not able to manage their symptoms with medication may choose surgical treatment (such as the removal of a segment of bowel) as a means of improving their quality of life. Without surgery, a patient's condition wouldn't necessarily deteriorate. In contrast, the presence of severe bleeding, a bowel obstruction, or a hole in the intestinal wall—all potential complications of Crohn's disease—would be considered a medical emergency. Surgery subsequently becomes necessary for preventing permanent damage or to save the patient's life.

Whether a surgical procedure is essential is important in determining whether it will be covered by health insurance. If a procedure is not considered "medically necessary" (i.e. is considered elective), most insurance companies will not pay for the procedure, or will provide only minimal coverage. A common example of an elective procedure that is not usually covered by insurance is cosmetic surgery. In some cases, however, an elective procedure is covered by health insurance because it is considered essential in improving the patient's quality of life. An example is breast reconstruction following mastectomy (surgical removal of the breast). While breast reconstruction is an elective procedure according to most definitions (i.e. it is not medically necessary nor considered an emergency), it is considered essential in restoring a woman's self-image following the removal of a breast for the treatment of cancer. A 1998 federal law (the Women's Health and Cancer Rights Act) states that insurance companies are required to cover breast reconstruction in patients who are covered for mastectomy.

Resources

BOOKS

Lally, Kevin P., Charles S. Cox Jr., and Richard J. Andrassy. "Appendix: Appendicitis" (Chapter 45), in Courtney M. Townsend, Jr., ed., Sabiston Textbook of Surgery, 16th ed. Philadelphia, PA: W. B. Saunders Company, 2001.

PERIODICALS

O'Connor, Robert. "Aneurysms, Abdominal."eMedicine, February 11, 2002 [cited May 18, 2003]. .

ORGANIZATIONS

American College of Surgeons. 633 N. Saint Clair St., Chicago, IL 60611-3211. (312) 202-5000. .

American Society of Plastic Surgeons (ASPS). 444 East Algonquin Road, Arlington Heights, IL 60005. (847) 228-9900. .

OTHER

Centers for Medicare and Medicaid Services. The Women'sHealth and Cancer Rights Act, January 20, 2003 [cited May 18, 2003]. .

Crohn's and Colitis Foundation of America. When is SurgeryNecessary for Crohn's Disease?, 2002 [cited May 18, 2003]. .

Stephanie Dionne Sherk