Elective Surgery Dynamics Prior/Subsequent to Covid 19, Dr. John Eliopoulos’ Vantage Point

by Elena Kefalogianni

The 2020 Covid-19 pandemic changed the world as we know it, presenting new challenges in all professions. Healthcare personnel found themselves at the front lines. Effectively battling the pandemic while shielding first medical responders translated to a reprioritization and restructuring of the field of surgery. An average of, alone, 30 to 40 million surgeries are performed every year, the pandemic resulted in the cancellation of 91% of elective surgeries and an economic impact of over $200 billion per year.

Dr. John Eliopoulos, completed his medical degree from Yale Medical School and his surgical training at Tufts Medical Center in Boston, where he later practiced as a general and vascular surgeon. He provided an insightful analysis of the devastating impact that postponement of elective procedures represented for many patients. “There’s no question if you had to wait to get your colonoscopy and you had colon cancer, you might convert from a curable lesion to an incurable one,” he said.

Dr. Eliopoulos suggests that we will see many future studies exploring the nexus between elective surgeries and procedures such as mammograms and other complications and death. The pandemic necessitated the cancellation of elective procedures given the dramatic constraints on the nation’s hospital system with overcrowding, shortages of protective gear and equipment, among other factors.

Photograph courtesy of John Eliopoulos

The US did successfully tackle the pandemic head-on through the production of vaccines, doubling-down on the production of medical equipment and supplies, nevertheless, the impact of elective surgery postponement continues to impact health care.  Dr. Eliopoulos believes that when a future pandemic hits, alternative routes to ensure elective surgeries continue is a priority. “A lot of surgery can be performed in a ambulatory surgery center which is a facility where

I performed multiple surgical procedures from gallbladder, breast and hernia operations in an ambulatory center. So it’s possible that in the future, they could delegate the surgery centers to do all of the elective surgery that cannot be done in the medical centers.”

Technology is changing health care as Dr. Eliopoulos describes that the growing use of telemedicine has dramatically reduced emergency and urgent care visits as well as personal office calls. He also forecasts that the use of robotics in surgery will continue to grow. “Last year, we saw about 10 million robotic surgeries performed in the United States.”

Despite the high price of maintaining robotic surgical units, the average cost is $2 million, robotic surgery offers significant benefits: minimally invasive procedures; smaller incisions, less scarring, inflammation and superior optic capability. This reduces postoperative pain and care management. “Even before robotic surgery, laparoscopic surgery was a terrific advance. For example, in a gallbladder procedure, the old way, involved a large incision with significant pain and reliance on pain medicine afterwards. That is no longer the case with modern day surgical procedures.”

While these advances carry risks should the equipment malfunction, collateral organ damage and the inability to use robotics during emergency surgeries, Dr. Eliopoulos expects to see technology and even artificial intelligence continuously evolving and changing health care.  “Artificial Intelligence (AI) provides a host of important information that helps the practitioner in making the right decisions. AI can quantify the results of 1000 operations and yield important data in making the right call. So, I think it will be helpful, but time will tell.”

Technology is important, however, even more important is developing a relationship between caregiver and patient. Dr. Eliopoulos continues providing his patients consultative care despite having retired from his practice. Patients need to have open communication channels with their caregivers, ask questions, understand the ramifications and be fully informed prior to making decisions about their health care. “Ask your doctor as many questions as you would like about what to expect in post-op, how much pain to expect and how to deal with it.  What medication will you be taking, what are the possible side effects and what other assistance will you need. Finally, it’s always important to get   a second opinion.”

Dr. Eliopoulos believes patients have an obligation to be completely honest with their attending physician. He recommends that quitting smoking and maintaining a healthy lifestyle are key factors in reducing some of the risks associated with undergoing an operation.