COVID

ASSESSMENT

Data Gathering

  • Previous diagnosis of COVID

    • Dates​

    • Symptoms (respiratory, cardiac, thromboembolic)

    • Treatments (outpatient, inpatient, ICU)

  • Persistent symptoms of COVID

  • Date(s) of COVID vaccination

MANAGEMENT

  • No previous infection or infection >90 days ago: nasopharyngeal PCR test ideally ≤3 days prior to the procedure

  • Infection ≤90 days ago: do not retest unless symptoms suggestive of re-infection

Duration of Isolation [ASA/APSF Statement]

  • Asymptomatic or mild illness:

    • 5 days after symptom onset (or 5 days after positive test if asymptomatic), no fever for 24 hours, & symptoms improving​

  • Moderate illness:​

    • 10 days after symptom onset, no fever for 24 hours, & symptoms improving​

  • Severe illness:​

    • 10-20 days after symptom onset, no fever for 24 hours, & symptoms improving

  • Moderate or severe immunocompromise:​

    • At least 20 days after symptom onset, no fever for 24 hours, & symptoms improving​

Surgical Delay After Infection [ASA/APSF Statement]

  1. Elective surgery should be delayed for 7 weeks after in unvaccinated patients

  2. Insufficient evidence for patients infected after SARS-CoV-2 vaccination

  3. Benefits of delaying surgery must be weighed against time-sensitivity of surgery

  4. If surgery is necessary prior to recommended delay period, potential risks should be included in consent discussions

  5. Extending recommended delay should be considered if persistent symptoms, including non-respiratory symptoms

  6. Decisions to proceed with surgery should factor in

    • Infection severity

    • Risk of ongoing symptoms

    • Comorbidities and frailty status

    • Surgical complexity

  7. Thorough preoperative evaluation, scheduled well before surgery and with extra focus on cardiopulmonary status, should be considered in patients recovered from COVID infection, especially if any residual symptoms​

Vaccination Considerations 

  • No data - only statements from RCS of England and Association of Anaesthetists

    • "Non-urgent elective surgery can also take place soon after vaccination. There is some rationale for separating the date of surgery from vaccination by a few days (at most 1 week) so that any symptoms such as fever might be correctly attributed to the consequences of either vaccination or the operation itself."​ [RCS of England Statement]

    • Complete pre-operative COVID-19 vaccination, with three doses wherever possible, with the last dose at least 2 weeks before surgery [AA/RCA/RCS Statement]