Think back to your SATs. Remember the analogies? The goal was to determine the relationship between the first pair of words and then choose the second pair of words that had an equivalent relationship. In the title above, ice cream shops are to takeout food as cosmetic surgery is to elective surgery. In other words, ice cream shops are a type of takeout food, just as cosmetic surgery is a type of elective surgery.
But one could also read it as, if ice cream shops are considered essential forms of takeout restaurants that should remain open when a shelter-in-place is in effect (which they are), then plastic surgeons should be able to perform cosmetic surgery if elective surgery is deemed appropriate during a shelter-in-place designation (which they’re not). They highlight an interesting conundrum that our elected leaders and public health officials currently find themselves in (even if they aren’t aware of it).
Is cosmetic surgery a legitimate form of elective surgery?
Across America, hospitals are starting to perform elective procedures again. They stopped elective procedures at the beginning of the COVID crisis because hospitals wanted to ensure beds were available for COVID patients. And with each elective operation, that was potentially one less bed for a COVID sufferer. Elective procedures range from a colonoscopy to breast cancer to heart valve dysfunction. If a patient was in imminent danger, they could have their procedure. If not, their operation was postponed.
Now as elective cases are added back to the elective operative schedule, hospitals are prioritizing which procedures should go first. In a recent email that I received from the Sutter Health system based in Sacramento, one parameter to determine whether an elective procedure could proceed was if the patient was likely to need less than 48 hours in the hospital postoperatively. Again, very reasonable considering that a quickly discharged patient would “free up” a bed for a potential COVID patient.
Ban cosmetic surgery?
Despite these recommendations, Governor Newsom went out of his way to ban cosmetic surgery. His thinking is that these are unnecessary procedures. But when is cosmetic surgery ever necessary? It’s not! So if these procedures are always unnecessary, what’s the distinction that makes them “more unnecessary” now, if other elective procedures are allowed? Additionally, most cosmetic procedures take place in outpatient surgery centers or in accredited office-based operating rooms (like ours). As such, they’re not taking hospital beds from COVID patients. These procedures aren’t even taking place in the hospital. And don’t forget, cosmetic surgery patients are inherently the healthiest patients as a rule.
Could there be a complication in an outpatient setting that would require transfer of a cosmetic patient to a hospital, thus taking a bed from a COVID patient? Certainly, but the data shows that’s not likely. Complications of any kind, including those requiring transfer to a hospital occur less than 0.5% of the time.
And how are our elected and non-elected leaders making these decisions? Based on a personal communication with another plastic surgeon, some hospitals in San Francisco are allowing transgender surgery to proceed, considering them to be essential elective procedures. So someone born as a man, undergoing gender affirmation surgery to become a woman can undergo a breast augmentation, or “top surgery,” but someone born as a woman can’t get breast implants for confidence affirmation surgery?
What are the current CMS recommendations for resuming elective procedures?
Where does the Centers for Medicare and Medicaid Services stand on this topic? They recommend elective procedures when the number of admissions to local hospitals are trending down, especially admissions to the ICU. They also want to ensure that staff has access to personal protective equipment (PPE) and that testing is available. Keep in mind the recommendations are in conjunction with the local climate of admissions and infections.
The ICU admission rate is going down in San Francisco. And the number of deaths is very low, especially when compared to other large metropolitan areas. The local climate is heading in the right direction. We have enough PPE in our office to protect patients and staff. We have access to rapid antibody testing in our office and will soon have access to rapid PCR testing. Lastly, since our patients are healthy and not having surgery in a hospital, they’re not taking COVID patient beds. Therefore, they seem to be the safest elective procedures to be performing at this time.
But I’m not here to argue that cosmetic surgery is essential. Or to allow it. Nor am I arguing whether ice cream shops should rise to the same level of essentiality of a takeout restaurant. What I am arguing is that if the government is setting parameters for elective procedures, just as they are for what is and is not an essential business, then there’s no logical reason to ban cosmetic surgery. These patients are not taking beds. They’re healthy. And in our office, they have access to all of the testing and PPE that CMS, and most organizations recommend. So Governor Newsom and Mayor Breed, set parameters and be consistent… and let my people go!