Procedure vs. Surgery

These are not the same thing, although they are often confused. Generally speaking, surgery involves cutting into the body to repair, remove, or readjust tissue or organs. A procedure, on the other hand, can involve looking into the body but usually does not involve making a new incision. Any intervention is most often carried out through a naturally occurring orifice.

Appendectomy, cholecystectomy, craniotomy, and total hip/knee arthroplasty are all examples of surgeries. Surgeries are performed under sterile conditions in the operating room. They usually involve general anesthesia, which includes placing a breathing tube in the trachea.

Lithotripsy, kidney/ureteral stent placement, cardiac catheterization, lumbar puncture, IUD placement, colonoscopy, and EGD are all examples of procedures. They may be done in an operating room or a procedure room and involve some level of sedation, but usually not general anesthesia. Patients may remain awake or at least breathe on their own without a breathing tube in their airway.

Why does this matter? Because words matter. Words need to be precise and concise when discussing medical issues. Both doctors and patients routinely fail to do this well, and when words are imprecise, the message gets lost. I have plenty of patients tell me they had a “surgery,” but when I ask deeper questions, it’s clear they had a procedure—which changes the things I think about and am concerned about. For example, colonoscopies are fairly routine with relatively low complication rates. A surgery to remove part of your small bowel and reattach the two ends, on the other hand, is a major operation, and the downstream potential complications are obviously not the same.

Doctors can better understand and accommodate this distinction because of our deeper knowledge of medical concepts. I think patients and their loved ones are harmed the most because they don’t understand the details.

As an ER doctor, I routinely get asked if I do surgery. The answer is no—I do procedures. The most common ones include laceration repairs, skin/superficial abscess drainage, intubations, chest tubes, lumbar punctures, arthrocentesis, and draining fluid from around the lungs or abdomen. Some are “clean” and some are “sterile” procedures, but they are not performed under full operating room conditions.

The level of sterility varies based on the procedure. Laceration repairs and abscess drainage involve the skin and are clean procedures. The laceration will be washed before the skin is closed, but your skin is not sterile—everyone has bacteria on their skin. Washing the skin around a laceration before closing it doesn’t make it sterile. Draining an abscess (a pocket of purulent material, or “pus”) obviously involves bacteria, so making the skin sterile before spilling the pus out provides no benefit. Wearing clean gloves is adequate, and studies don’t support the need for sterile gloves or keeping the entire procedure sterile.

Putting needles into sterile spaces, on the other hand (i.e., entering the inside of the body into a normally sterile space), requires sterilizing the skin around the insertion site. You don’t want to introduce bacteria into the body. Sterile gloves are required.