Preparing previously COVID-19-positive patients for elective surgery: a framework for preoperative evaluation

Abstract

The preoperative evaluation and risk assessment has always been a critical aspect of safe surgical practice, and in the midst of the SARS-CoV-2 pandemic, it has become even more crucial to patient safety. Emerging data show that surgical procedures in patients who test positive for coronavirus disease (COVID) are associated with worse clinical outcomes and increased postoperative complications and mortality. In addition to personal protective equipment (PPE) management, isolation protocols, preoperative SARS-CoV-2 screening, and steps to ensure clinician safety, determining how to deem patients who have recovered from COVID-19 safe to proceed is an added challenge. We present a preoperative protocol for evaluation of previously COVID-positive patients for elective surgery.

Elective laparoscopic colectomy in a patient 3 weeks after coronavirus disease 2019 infection: a case report

“…Some studies have reported that D-dimer measurement for deep thrombosis may be superior to ultrasound [6] because thrombosis in areas other than the lower limbs may be present. However, high D-dimer may be seen in malignant tumors even in the absence of blood clots [8], which may lead to excessive unnecessary use of anticoagulants.…”

“…Elective laparoscopic colectomy can be postponed for up to 3 months when colon cancer is in stage III or lower, considering that surgical treatment would be difficult in situations of tumor progression [4]. According to previous reports, surgery is not recommended until at least 4 weeks after the symptoms of COVID-19 resolve to be considered safe [5,6]. However, there has been no strong evidence on how to resume postponed elective laparoscopic surgery.…”

Anesthetic Management in an Infant with Dandy–Walker Syndrome Presenting with Acyanotic Heart Disease and Hydrocephalous Post-COVID-19 Recovery: A Rare Experience

“…Perioperative concerns for surgery in such cases are false-negative RT-PCR in children, low yield of viral ribonucleic acid (RNA) from nasopharyngeal samples, nonspecific symptomatology, risk of perioperative viral aerosolization, postviral reactive airway with critical respiratory events during extubation, unexpected postop ventilation, and myocarditis (38-50%). [5][6][7] Data on clinical outcomes in pediatric patients with COVID-19 undergoing emergency surgery is sketchy and mostly extrapolated from adult studies. [5][6][7] This was a multidisciplinary effort involving cardiac-and neuroanesthesiologists and cardiac and neurosurgeons with perioperative intensive care management for successful outcome.…”

Pushing the Envelope

“…These patients should not have elective surgery or procedure until after eight weeks or three months, respectively. Similarly, in the Case of symptomatic COVID-19, the authors recommend that patients ideally should wait a minimum of 8 weeks before elective surgery or procedure 60 .…”

“…Going forward, as more of the population become infected with and recover from COVID-19, it will be essential to build a framework and approach to treating these previously COVID-19 positive patients 60 . Many of them may have had to delay surgeries because hospitals had canceled elective procedures or because the patient had COVID-19, whether symptomatic or not.…”