Timing of elective surgery and risk assessment after SARS‐CoV‐2 infection: an update

Abstract

The impact of vaccination and new SARS-CoV-2 variants on peri-operative outcomes is unclear. We aimed to update previously published consensus recommendations on timing of elective surgery after SARS-CoV-2 infection to assist policymakers, administrative staff, clinicians and patients. The guidance remains that patients should avoid elective surgery within 7 weeks of infection, unless the benefits of doing so exceed the risk of waiting. We recommend individualised multidisciplinary risk assessment for patients requiring elective surgery within 7 weeks of SARS-CoV-2 infection. This should include baseline mortality risk calculation and assessment of risk modifiers (patient factors; SARS-CoV-2 infection; surgical factors). Asymptomatic SARS-CoV-2 infection with previous variants increased peri-operative mortality risk three-fold throughout the 6 weeks after infection, and assumptions that asymptomatic or mildly symptomatic omicron SARS-CoV-2 infection does not add risk are currently unfounded. Patients with persistent symptoms and those with moderate-to-severe COVID-19 may require a longer delay than 7 weeks. Elective surgery should not take place within 10 days of diagnosis of SARS-CoV-2 infection, predominantly because the patient may be infectious, which is a risk to surgical pathways, staff and other patients. We now emphasise that timing of surgery should include the assessment of baseline and increased risk, optimising vaccination and functional status, and shared decision-making. While these recommendations focus on the omicron variant and current evidence, the principles may also be of relevance to future variants. As further data emerge, these recommendations may be revised.

Association between COVID-19 and Postoperative Neurological Complications and Antipsychotic Medication Use after Cancer Surgery: A Retrospective Study

“…Second, we analyzed data from patients with a history of COVID-19 infection who were PCR-negative at the time of surgery and had most likely recovered from any COVID-19-like symptoms. In other terms, surgeries included in our analysis took place on highly selected patients, typically 4–8 weeks after the infection, who might have fully recovered from the infection, and with minimal or no COVID-19 sequela in the neurological system [ 34 ]. Thus, patients with any neuropsychiatric disorder or still symptomatic from the infection might not have undergone surgery during the period of our study or might have received different cancer treatments.…”

Perioperative Infection Control Recommendations during the SARS-CoV-2 Omicron Variant Pandemic

“…A study across 116 countries or regions of COVID-19 patients receiving elective or emergency surgery from October to November 2020 indicated that postoperative mortality rate increased for those receiving surgery within 6 weeks of infection and returned to baseline for those receiving surgery after 7 weeks of infection [21] . However, COVID-19 patients with mild symptom or without symptom does not increase perioperative risks [17,20] . The number of Omicron cases increased significantly with most cases being asymptomatic or mildlt symptomatic.…”

The Effect of the COVID-19 Pandemic on the Surgery Process

“…Health professionals who take part in the preparation of the patient before the operation should use personal protective equipment, attention to hand hygiene and social distance rules (11). Before the pre-operative evaluation of the patient, nurses and doctors should collect their hair, wear a hospital gown, and tuck the trouser legs of the clothing into boots that fully cover the ankles, without holes and, if possible, sterilizable.…”

“…In these patients, all pre-, intra-, and post-operative precautions should be considered until the diagnosis is confirmed or the patient is discharged (13). Patients diagnosed with or suspected of COVID-19 should be taken to a separate area from patients who have proven to be negative for COVID-19, different predetermined routes should be used during in-hospital transfers, and if possible, they should be admitted to a single room to prevent crossinfection (11,13,15). It is recommended to clarify the patient's status of being infected with COVID-19 by obtaining a nasopharyngeal PCR sample 48-72 hours before surgeries other than emergency surgeries in a previously designated isolated area of the hospital (10,14,16).…”