When to Operate After Failed Nonoperative Management

Initial nonoperative management of patients with acute pathology is commonplace for several disorders. Inherent in this decision is the belief that surgery is best performed in a delayed fashion (when conditions are more favorable, both for the patient and the surgeon) or that surgery can be avoided altogether. However, despite our best intentions, nonoperative management will fail in a certain subset of patients initially believed to benefit from such an approach. In this chapter, we will discuss when to consider operative management (and, consequently, how to recognize that nonoperative management has failed) for several common conditions seen by general and acute care surgeons. Since these topics have already been described elsewhere in the text, details regarding epidemiology, diagnostic evaluation, and specific operative approaches will only briefly be discussed.