Why - and why not - to have surgery during the holidays

You've been putting off that elective procedure - say a hernia repair or knee replacement - for a while now because you don't want to take time away from work.

But now you have time off around Christmas and New Year's, and you're thinking "why not now?" Maybe you also have some medical benefits you need to use up before Dec. 31, or you've met your insurance deductible for the year, so the procedure won't cost as much.

Holidays are a popular time to schedule elective surgeries, but there are some important considerations before you decide to give yourself a new knee for Christmas.

On the plus side are these factors:

• Your spouse or other family members may have time off, too, so they're available to help you when you get home after your surgery. Of course, it's important to check with them to make sure they're OK with your plan.

• The weather outside is frightful, so you won't be missing out on many outdoor activities and can chill on the sofa with a warm drink. If you have to wear a compression garment after a procedure such as liposuction, it may be more comfortable during colder weather.

• You'll be rested and ready for the new year.

But there can also be downsides to having surgery during the holidays.

Surgeons, like many other people, like to take time off around the holidays. This means if you schedule an operation during the Christmas season you may end up with a different doctor than you expected.

"Everybody is looking for a surgeon who is known for very good outcomes, is experienced, and does a large number of cases, but that type of surgeon is more likely to be on vacation during the holidays," says Eugene Litvak of Harvard's T.H. Chan School of Public Health and an authority on hospital quality assurance.

Hospitals also have slightly worse patient outcomes during holidays and weekends, though it's not clear why that is. It might be that people engage in riskier behaviors over the holidays, like overindulging on New Year's Eve, or take themselves to the ER on Christmas Eve after feeling crummy all week, making them sicker and delaying treatment.

It may also have to do with availability of experienced staff. Senior doctors and nurses typically get first dibs on holiday time off, leaving a smaller, less experienced medical staff in charge more often. Even if your doctor is available to do your surgery over the holidays, the more experienced nurses, OR technicians and anesthesiologists may not be on call.

Test results may be delayed, too, because the scanning facilities are understaffed, or the experts who interpret the results aren't around. If that knee replacement encounters a complication, it may take longer to get an MRI or X-ray.

By now, it should be pretty clear I'm not a fan of scheduling surgeries over the holidays, no matter how convenient it may be for the patient. Here are a few suggestions.

• Ask your doctor if there are risks in delaying surgery, or get a second opinion.

• Try to schedule surgeries midweek. Friday may seem an attractive option because you have the weekend to recover, but if complications arise you may be seeing an unfamiliar doctor or you could even be stuck in the hospital until Monday.

• If you must go to a hospital during a holiday, have a family member or friend stay with you until you're discharged. Having an extra pair of eyes and ears, and an advocate, is always a good idea, whether or not it's a holiday. Make sure you have a power-of-attorney for health care or HIPAA form giving the advocate the right to information about your care.

• Ask questions. If the answers aren't clear or satisfactory, ask for a second opinion.

• If tests are ordered, ask why and then follow up to make sure you're informed of the results.

• If your condition seems to be worsening and no doctor is around, be firm with the nursing staff. Ask them to page or call the doctor. If you're told they can't reach the doctor, ask to speak with a charge nurse and insist they page another physician.

• It helps to know the hospital chain of command if you encounter problems: caregiver, nurse, nurse manager, supervisor, risk management department, director of nursing and CEO, in that order.

Harvard's Litvak has one more bit of advice: If you've put off your surgery until after the holidays, don't schedule it early in the new year, when hospitals and doctors may be overwhelmed trying to catch up from over the holidays.

So, how's February for you?

• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). She is offering a free phone consultation to Daily Herald readers; call her at (847) 612-6684.