[Closed] Probability / Odds / Death.

Where did that 20% come from? I can't follow your working?

20% for an op on your hand? Surely they'd only take that risk if it was immediately life threatening?

Where did that 20% come from? I can’t follow your working?

What the Consultant told me, if you have Covid and you go under a General, there's a 20% chance of dying.

However, if I have a General, I’ll have a 20% chance of dying on the table, or shortly afterwards.

This seems highly unlikely unless you have a pre-existing condition that means that a GA is super dangerous for you.

IANAD obvs

Given my age, general fitness, BMI, ethnicity and lifestyle there’s a 95%ish chance I won’t even notice, a 4% chance I’ll have a cold-like infection, 1% chance I’ll be really ill and then it tapers down to tiny chance I’ll need hospital care or die.

More likely he meant that, if you are unlucky enough to fall into the 1 % of really ill Covid patients, and then subsequently have a GA then you have a 20% chance of croaking it.

So in reality it's 20% of 1% i.e 0.2%

Ah IF you've got covid. Shirley if the local doesn't work sack it off until after Covid?

However, if I have a General, I’ll have a 20% chance of dying on the table, or shortly afterwards.

Where does this 20% figure come from? Do you have an underlying condition that prevents the use of a general anaesthetic?

From the information you've provided, there's no link between the form of anaesthetic and contracting Covid-19.

Edit: too slow!

OK, even if you contracted Covid-19 whilst there for your operation, there's an incubation period. Surely that 20% refers to those patients with obvious symptoms, i.e. beyond that timespan.

I have a 95% chance I will be having my Op under a local. The 5% represents either they can’t find the right Anaesthetist who can work in my hand, or it doesn’t work for whatever reason.

However, if I have a General, I’ll have a 20% chance of dying on the table, or shortly afterwards.

I don't like the possibility that there is a 1:20 chance that the right guy is not around and then you end up with a really high risk alternative (1:5). Normal GA mortality is something like 1:100,000 - is there a reason its so high. Is there a reason not to wait till the "right guy" is available?

20% for an op on your hand? Surely they’d only take that risk if it was immediately life threatening?

That's the thing that's spun my head really.

It's urgent, but not life threatening at all. I've got some metalwork from a break 10 years ago, two of the screws have worked their way into the joint and are causing damage and quite a lot of pain. Not enough to stop me working / riding though, I'm more concerned about the long-term damage. When she saw the scans in Feb, before the world stopped, she wanted to do it ASAP, but they cancelled all electives a few days later.

if you have Covid and you go under a General, there’s a 20% chance of dying.

Which is why you get tested before going into hospital. So getting tested, ensure you don't have Covid and then keep out the way of everything until you go into hospital so don't catch it in the meantime.

Also don't get the link between having cover and a very high 20% risk of death from GA but maybe the surgeon has other motives?

What the Consultant told me, if you have Covid and you go under a General, there’s a 20% chance of dying.

That's a conditonal probability, no one would operate on a hand if there was a 1:5 chance of death! They'd only operate with those odds if the op was life saving ie a higher chance of you dying without the operation.

Covid is not going away.

Get the op done.

1 in 200 chance of contracting COVID is 0.5% . (Regardless of length of stay, so if you're in as a daycase your risk will be lower than an elderly patient with multiple complications who is on a ward for three weeks)

5% chance of having a general (although as a poster above has said, they can simply choose not to give you a general anaesthetic and the chance goes down to zero).

Then a 20% chance of dying if you have COVID and a general anaesthetic. (Although I wonder if those odds are for people already ill with COVID who are then put under, rather than a fit and healthy person having a general anaesthetic and then catching COVID on a ward 24 hours later).

So, the odds of you dying if all of the individual bits are correct is:
0.5% * 5% * 20% = 0.005% or 1 in 20,000.

I'd suggest that wearing a mask at all times and washing your hands religiously for the few hours that you're in the hospital would greatly improve that.

My wife is going in for a hip replacement in 2 weeks time. Consultant has required her to self isolate for 2 weeks before the op - she's stuck in her bedroom alone for the next 2 weeks to ensure she doesn't have COVID.

I will drive her to the hospital with us both masked up.

This seems the best approach - make sure you're chance of having COVID is as close to zero before the op and relax.

Where does this 20% figure come from? Do you have an underlying condition that prevents the use of a general anaesthetic?

From the information you’ve provided, there’s no link between the form of anaesthetic and contracting Covid-19.

Figure came from the Surgeon, it was so "matter of fact" it took a little minute to sink in, It's still in the very low risk cat.

I'll be tested 3 days before the Op and self-isolate from then until the Op, I'll only be in the hospital for a matter of an hours pre-op and then home again within a few hours.

She was very keen for me to have a local pre-covid, the recovery is quicker, I was NOT keen, I have anxiety, a lot of which was caused by some PTSD from the accident I broke the bloody thing in the first place. I've had 3 surgeries already because of that crash, but always under a general. When I had 'the snip' a few years ago, I managed to talk them into letting my wife come in but even so, I nearly fainted at one point and they had to stop.

Ummm
Ask for a covid test 48 hrs prior to the op
If its clear, roll the dice
If you fail put the op on hold for a few months
Mum had cataracts done last week, and at 82 covid test was mandatory
Relax, no one is forcing you to do any thing you don't want to
Assess the situation, read the informed posys on here, speak with consultant, make informed decision

Or don't, its entirely up to you

X post fail

My daughter has an op scheduled at the start of October - under a general anaesthetic. She will be isolating for 2 weeks beforehand and will also be tested for Covid. If she tests positive the op will be rescheduled. I assumed this was standard practice.

So, there's a risk she could contract Covid while in hospital but it otherwise doesn't appear to affect the risks due to the op itself.

Not sure if this applies for the OP, I know I've done this in the past. Faced with some difficult & anxiety inducing dilemma there's a temptation to try and reason and analyse your way to the "best" solution. It just can't be done and the mental effort focusses you more and more on the source of the anxiety making it worse and more difficult to reach a solution.

We had to make a similar call last month around a major op for our daughter. We went for it in the end because there was no certainty there would be a better time. Leaving it was certain to cause more suffering.

The chance of you picking up Covid in hospital is wholly unrelated to the risks of anaesthesia on that visit. Your surgeon is talking about going under general anaesthetic with an existing raging Covid infection, which obviously takes a good few days to get going post exposure.

I am not sure where your consultant is getting his 1 in 5 figure from - I've not seen any reliable evidence of covid-related operative mortality. 20% is massively above normal anaesthetic risk.

I would expect you to be tested before admission, and the op cancelled if you already have Covid.

I think ops will start getting cancelled again anyway before too long, so my approach would be to get it done quick or be prepared to wait until well into next year.

She was very keen for me to have a local pre-covid, the recovery is quicker, I was NOT keen, I have anxiety, a lot of which was caused by some PTSD from the accident I broke the bloody thing in the first place.

Have another conversation with your consultant - is a local anaesthetic plus heavy sedation a possibility?

When I had my hip replacement done I was insistent that I had a general anaesthetic as I didn't want to be awake during the procedure but the anaesthetist persuaded me to have a local. They did knock me out for the start but that wasn't GA just sedation.

That 20% figure sounds more and more like the figures for patients already on ventilation, or close to being so, to handle impaired lung functionality along with the other complications from severe Covid-19. If you walk into the hospital, Covid free, then that's irrelevant and I don't understand why your consultant raised it as a matter of concern.

Just overthinking isn't it?

Have another conversation with your consultant – is a local anaesthetic plus heavy sedation a possibility?

Oh god yes, I'm having ALL the drugs.

Just overthinking isn’t it?

I know no other way.

It's probably telling that I walked out of the meeting completely untroubled by it, it was 2 days later it started to bother me.

Figure came from the Surgeon, it was so “matter of factan educated guess”

As others have explained above, they are estimating that someone who has a full-blown covid infection and undergoes GE will have an 80% survival expectancy. Plus they are making other estimates about the likelihood of getting infected and having to have a GE. In reality, if you had a full-blown covid infection, it would be very unlikely that it wasn't spotted and they would absolutely not waste time operating on your hand if that meant requiring a GE with a 20% chance of death. So, in reality, the operation itself is not really any riskier than normal and their estimates are really just about the absolutely worst-case scenarios. The risk is just going to the hospital and potentially getting a covid infection there, but if you need an operation and take sensible precautions such as wearing a mask, you should get your operation.

OP
What you've written makes no sense, which is understandable given the state you're in.

Either the doc explained it to you badly, or you've written it badly.

Can you try again to phrase what he said?

So, the odds of you dying if all of the individual bits are correct is:
0.5% * 5% * 20% = 0.005% or 1 in 20,000.

I think is the correct answer. Compound risk.

On the other hand - sorry! - you might get hit by lightning on the way to the hospital.

6 weeks ago I had part of a lung removed and my chance of dying or catching covid was 1%. The hospital staff did everything possible to prevent any covid infections. Self isolate 2 weeks before and 2 weeks after plus tests is what I had to do.
I suggest you get it done whilst the hospitals are fairly empty.
Ps can I have your bike if it all goes Pete tong 😊

Patients for ops or proceedures in the hospital I work in get a covid test & have to isolate for 24days before the op even if the test is negative.

Just go for the op.

With all the traffic, you're probably at greatest risk from dying during your journey to the hospital

OP
What you’ve written makes no sense, which is understandable given the state you’re in.

Either the doc explained it to you badly, or you’ve written it badly.

Can you try again to phrase what he said?

He, is a She, but that's not important.

She said

"The risk of dying from a Covid infection with a General Anaesthetic is one in five".

Now I've said it out loud, even with all the precautions taken to ensure no one with Covid has an operation, it just seems to risky to be right. I'd think in order to even work out the statistics, there would have been too many deaths to even risk non emergency surgery at the moment.

“The risk of dying from a Covid infection with a General Anaesthetic is one in five”.

Still not easy to interpret:

a) The risk of dying as a result of GA while infected with Covid is 1 in 5
b) The risk of dying from Covid infection following a GA is 1 in 5

Again, it doesn't define what type of Covid patient we're talking about - someone asymptomatic who has tested positive, someone with mild symptoms, or someone requiring ventilation?

I'd still want to know what evidence this is based on. The 1 in 200 Covid chance, regardless of length of stay, state of the patient, or reason for visit, is equally suspect. A long-term inpatient is likely to be at much higher risk of acquiring the infection compared with someone who pops in for an outpatient appt. Stating all patient episodes carry the same risk merely means they haven't tried to quantify those differences.

All in all, I'd want a second conversation if it is troubling you. Although I'd always opt for a local anaesthetic over a general where practicable.

What the Consultant told me, if you have Covid and you go under a General, there’s a 20% chance of dying.

That sounds like an estimate of the likelihood of death after ventilation with COVID19. It seems to have effect and cause the wrong way around. If you are sufficiently ill with COVID that you need ventilation and a GA, then I can well believe the 20% mortality - it's higher in older groups.

Surely at the moment patients are being tested for COVID before any surgery? Anyway, based on my experience of shoulder surgery I would go for local. I wasn't keen but the anaesthetist promised "something to fix any discomfort" and it was all fine. I had my iPhone playing tunes and watched the op on the big screen (that bit wasn't mandatory though so I'm sure you could avoid it).

Maybe phone the surgeon's secretary and politely ask for a clarification of the risk when the surgeon has a minute.

MoreDashThanCash sed> On the other hand – sorry!

Was funny.

The figure is from the covidsurg project. Surgery under GA and covid + around time of surgery had 20% mortality when all patients across all surgery were reviewed.

It's a huge mixed group and at a time when covid community levels were higher, no distancing in hospitals, no screening, no covid minimised pathways so numbers are questionable but they are the only numbers anyone has.

jet(surgeon but not hands)

that 20% does sound like bollocks (or rather, they've descrbed something not really relevant to your situation where you'd be asymptomatic on day of (fairly minor) surgery) - as does the practice of offering a single aggregated covid risk rate for ALL hospital admissions. I assume that all hospitals are currently doing elective procedures under conditions as close as they can get them to "covid-free" (our place isn't completely typical but we're testing all relevant staff once a week and then also doing what others have said about getting elective patients to isolate, pre-test and then only come in if they're symptom-free. The we temp-test them and show them the door if they've a fever)

hopefully your consultant can clarify what they meant - and of course you can always state in advancew that you "won't" have it under a general (which may be all they're trying to convince you to say anyway ! 😉 )

You are absolutely overthinking this. Trust the anesthetist, they will not want to put you at undue risk.

If the metalwork is impacting your quality of life get it sorted.

I'm guessing there are a number of anaesthetists reading this and sitting on their hands to avoid poking fun at the idea of orthopaedic surgeons using numbers to explain anything...

😉

I am an anaesthetist.

The 20% figure comes from a paper early on in the outbreak, the risk factors were being male, over 70, having significant pre-existing illness, emergency surgery and having major or cancer surgery.

By the time you account for having two screws out under local, the risk is very low. Even if they had to convert to GA halfway through, the overall inflammatory effect on your body would be tiny, so on the basis of the procedure you're having, I wouldn't be worried on your behalf.

Also, the hospital should swab you for coronavirus before you go, and they'll only let you in if you're negative.

Short version: No one involved will risk your life for the sake of taking two screws out.

Going to a hospital will expose you to a slightly higher likelihood of getting c-19. Having an operation does also exposes you to a risk of dying.
But in the otherwise my 90 year old mother had a hip replacement done under local 3 years ago. It scares the shit out of me. She had a nice chat with the staff as the bone saws were going in on the other side of the curtain.
6 years ago I had what was for me a traumatic eye operation under local. I had a very attractive lady nurse holding me down. I still keened all the way through it.

Surgery under GA and covid + around time of surgery had 20% mortality when all patients across all surgery were reviewed.

It’s a huge mixed group and at a time when covid community levels were higher, no distancing in hospitals, no screening, no covid minimised pathways so numbers are questionable but they are the only numbers anyone has.

Yes. It’s also in the context of a hospital system that had completely shut down as much work as possible to cope with a predicted surge in people needing ventilators. Surgery was for severe illnesses only. So these are people admitted to hospital with an illness/injury severe enough to warrant surgery at a time when that bar was very high, who also happened to have Covid.

Moreover, at that sort of time, Covid deaths as a percentage of Covid hospital admissions was ~5-10% ish. The fact that death risk was only increased 2-4-fold is surprising.

I’ve heard the ‘20%’ stat banded around far too much in hospitals. It doesn’t stand up to scrutiny and shouldn’t be used IMO.

The other thing worth bearing in mind is that it’s certainly possible that we’re in for a painful 6-12 months in healthcare. Now may be the safest time to get something done in the short-medium term.

Haven't read all the responses, but has anyone asked what the operation is to do? If it isn't done, how inconvenient to you is it? If it is impacting absolutely everything you do to the point you can't do anything, then perhaps the 20% risk isn't as bad as the 100% cant do anything.

If you can live with the inconvenience of whatever is wrong with the hand, then the 20% risk suddenly is more of an impact.

I'd be likely to take the risk if the hand was stopping me doing everything, but if it was bearable, then I'd be asking for the op to be down once Covid dies down.

I'm not a doctor, mathematician, statistician or gambler...so I'm looking at those odds and trying to work out if they make sense in my head...

The OP has said that his consultant was recommending this was done ASAP before lockdown, and that he is in pain from it. If he doesn't get it done now, he'll be waiting until the middle of next year, in all likelihood.

The question is whether the odds relayed to him bear any real relation to the actual risks of getting his hand fixed.

I have no medical expertise, but jonnyweale's post makes complete sense and wraps it up for me.

The obvious STW answer is to get a 6" length of broom handle, clench it in your teeth, and dispense with anaesthesia.

I'm sure I've seen that in a Crimean War medical manual somewhere.

The obvious STW answer is to get a 6″ length of broom handle, clench it in your teeth, and dispense with anaesthesia.

I’m sure I’ve seen that in a Crimean War medical manual somewhere.

Actually, the traditional way involved two pints of rum. One for the patient, one for the surgeon.

It sounds to me that the surgeon wants to do the op under local and you've asked to have it done under a general due to the issues you mentioned. My guess would be that the casual use of the 20% stat is what she sees as being the easiest way to convince you to do the op under a local.

I'm not saying she's wrong to want to do it under a local, I'd assume that if that's her preference then there are reasons (maybe faster discharge time, improved outcomes, etc).

She said

“The risk of dying from a Covid infection with a General Anaesthetic is one in five”.

That's still a nonsensical statement. I don't have a 20% chance of croaking from covid under general, mainly because I'm not planning on having a general. ( Or indeed any operation in the near future)
She needs to elaborate more on who she's talking about.

Is she saying that 20% of people who do have a general in the next X weeks are going to die?
If so I don't believe that either.

Or is she saying that 20% of people who have covid when they go under general will croak?

Etc

I am an anaesthetist.

The 20% figure comes from a paper early on in the outbreak, the risk factors were being male, over 70, having significant pre-existing illness, emergency surgery and having major or cancer surgery.

By the time you account for having two screws out under local, the risk is very low. Even if they had to convert to GA halfway through, the overall inflammatory effect on your body would be tiny, so on the basis of the procedure you’re having, I wouldn’t be worried on your behalf.

Also, the hospital should swab you for coronavirus before you go, and they’ll only let you in if you’re negative.

Short version: No one involved will risk your life for the sake of taking two screws out.I am an anaesthetist.

The 20% figure comes from a paper early on in the outbreak, the risk factors were being male, over 70, having significant pre-existing illness, emergency surgery and having major or cancer surgery.

By the time you account for having two screws out under local, the risk is very low. Even if they had to convert to GA halfway through, the overall inflammatory effect on your body would be tiny, so on the basis of the procedure you’re having, I wouldn’t be worried on your behalf.

Also, the hospital should swab you for coronavirus before you go, and they’ll only let you in if you’re negative.

Short version: No one involved will risk your life for the sake of taking two screws out.

Thanks for that, that's the sort of real world knowledge I was hoping for.

I also sort of glad I hadn't misunderstood the 20% thing or dreamed it or whatever.

Or is she saying that 20% of people who have covid when they go under general will croak?

Yes.

It sounds to me that the surgeon wants to do the op under local and you’ve asked to have it done under a general due to the issues you mentioned. My guess would be that the casual use of the 20% stat is what she sees as being the easiest way to convince you to do the op under a local.

I’m not saying she’s wrong to want to do it under a local, I’d assume that if that’s her preference then there are reasons (maybe faster discharge time, improved outcomes, etc).

We're talking about 2 different meetings at two very different times.

Back in Feb, when we first discussed it, I REALLY wanted a General, they hold no fear for me, I've had 5 surgeries under a general over the last 10 years or so. The surgeon recommended a local for a quicker recovery, and I agreed to. Obviously that all got cancelled.

A few days ago I had the same pre-op meeting because so much had changed, now a GA was far higher risk (if I happened to have Covid at the time) so much so I had to be made aware that if if the unexpected happened and I had to have a GA then I had to accept a 20% chance of mortality IF I had Covid at the time, but as above, that doesn't seem to be nearly the whole story.

The procedure now is, I have a Covid swab 72 hours prior to surgery and I isolate until it's done, which is a whole other problem we need to work out.

Recent research done by UCLA and Stanford university has concluded that if you are between 50 and 64 years of age, without significant comorbidities, your likelihood of dying from Covid is............
19.1 million to 1
A figure that improves with reduced age.

Good luck to the OP, for the OP.

Improve the odds of Covid not affecting you in a serious way, if you're not already, get taking Vitamin D supplements!

Your surgeon is probably struggling to get an an anaesthetist In the private sector as most are busy with NHS work. It’s much easier for him/her to push local anaesthesia. This will have some bearing on the risks you are given. a GA has negligible risk even now with proper screening

jonnyweale ^^^ has is it.
With them being an anaesthetist, I would have confidence in his/her comments.
As this is STW it's possible that a hand surgeon will drop in with some contrary comments; if that doesn't happen, crack on - you're over thinking.