Post-COVID Patients: Timing of Elective Surgery

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As the U.S. slowly recovers from the pandemic and COVID hospitalizations decline, a backlog of surgeries is beginning to clear as facilities resume elective surgical procedures.

Over the past year, guidelines for performing elective surgery in the setting of COVID have been available from the American College of Surgeons, American Academy of Orthopaedic Surgeons, American Society of Anesthesiologists, and other national authorities. These recommendations have focused on issues such as: ensuring adequate availability of critical care resources, hospital beds, and personal protective equipment in the setting of the pandemic; minimizing the risk of COVID transmission between patients and healthcare personnel; and screening preoperative surgical patients for active COVID infection. While COVID mitigation efforts are still very important, these issues are less frequently creating a barrier to proceeding with elective surgeries.

More recently, as active COVID infections continue to decrease, guidance has emerged addressing the timing of elective surgery for patients who have recovered from COVID-19 and the unique risks involved with those patients. The residual effects of “long COVID” are still unknown, and research has demonstrated an increased risk of pulmonary complications and death in surgical patients who were previously infected with the SARS-CoV-2 virus. For post-COVID patients, in light of the potential for perioperative complications, the timing of elective surgery is a decision that should be made jointly by all members of the care team with consideration of patients’ complete histories.

In March 2021 the American Society of Anesthesiologists (ASA) and the Anesthesia Patient Safety Foundation (ASPF) released an updated Joint Statement on Elective Surgery and Anesthesia for Patients After COVID-19 Infection. The statement addresses testing and transmission-based precautions for patients following resolution of COVID symptoms, as well as the appropriate waiting periods to minimize COVID-related complications.

To minimize the risk of postoperative pulmonary complications, the ASA/APSF recommends the following wait times from the date of COVID-19 diagnosis to surgery:

  • 14 weeks for an asymptomatic patient or recovery from only mild, non-respiratory symptoms.
  • 6 weeks for a symptomatic patient (e.g., cough, dyspnea) who did not require hospitalization.
  • 8-10 weeks for a symptomatic patient who is diabetic, immunocompromised, or hospitalized.
  • 12 weeks for a patient who was admitted to an intensive care unit due to COVID-19 infection.

It is important to note that the above time periods are only general recommendations, and do not account for individual variations between patients. Providers should consider this information and incorporate it into their individual clinical decision-making, as appropriate.