Table 1 Summary of national organisations’ guidelines and consensus statements on post-COVID-19 patients requiring elective surgery
Organisation | Recommendations | ||
|---|---|---|---|
Delay between COVID-19 infection and elective surgery | Preoperative assessment for those with recent COVID-19 infection < 7 weeks | Considerations for long COVID patients | |
Consensus statement: Association of Anaesthetists, Centre for Perioperative Care, Federation of Surgical Specialty Associations, Royal College of Anaesthetists, Royal College of Surgeons of England (El-Boghdadly et al. 2022) | At least 10 days after infection, ideally > 7 weeks | • Assess baseline risk using validated risk assessment tools • Optimise where possible • Involve multidisciplinary decision-making, including additional assessment of patient factors, surgical factors and COVID-19-related risk | If persistent symptoms, consider further delay beyond 7 weeks based on a multidisciplinary risk/benefit assessment |
Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) (Cortegiani et al. 2022) | At least 10 days after infection, ideally > 7 weeks, unless the benefit outweighs the risk | • Risk assess patients using validated tools and multidisciplinary decision-making, including COVID-19-related risk and surgical factors • Optimise where possible • Use the SIAARTI preoperative assessment protocol to guide investigation requests based on surgical complexity and COVID symptoms at the time of infection | If persistent symptoms, consider further delay beyond 7 weeks based on a multidisciplinary risk/benefit assessment |
Germany Society of Surgery and Germany Society of Anesthesiology and Intensive Care Medicine (Noll et al. 2022) | Ideally > 7 weeks | Nil specific | If persistent symptoms, ideally delay surgery |
American Society of Anesthesiologists and Anesthesia Patient Safety Foundation (American Society of Anesthesiologists and Anesthesia Patient Safety Foundation 2022) | • 7 weeks in unvaccinated patients who are asymptomatic at the time of surgery • There is insufficient evidence to make recommendations for patients infected with COVID-19 after vaccination | Informed decision-making with the patient regarding the increased risk, taking note of illness severity, ongoing symptoms, comorbidities and surgical complexity | • Consider further delay if ongoing symptoms • These patients need a thorough preoperative assessment, focusing on the cardiopulmonary system |
The Australian and New Zealand College of Anaesthetists (Australian and New Zealand College of Anaesthetists 2022) | ◦ Minor surgery: 4 week delay ◦ Major surgery: delay for at least 7 weeks | • Risk assessment, considering patient, surgical and COVID factors • Shared decision-making is needed • Discuss patients with haematology regarding perioperative thromboprophylaxis | • Undertake a formal clinical review, involving all organ systems • Consider brain natriuretic peptide (BNP), ferritin and echocardiography based on the patient’s functional limitation and severity of infection • Consider a repeat chest X-ray (CXR)/CT chest • Cardiovascular or respiratory complications post-COVID-19 should be optimised |
Indian Society of Anaesthesiologists (Malhotra et al. 2021) | Interval depends on the following: • Illness severity • The presence of organ damage following infection • Relevant drugs involved in the management of COVID-19 | All patients should have the following: ◦ Ambulatory saturations ◦ An estimation of exercise tolerance and assessment of functional status, e.g. via a 6-minute walk test ◦ A review of affected organ systems and drug history ◦ Baseline bloods and ECG. Further investigations, e.g. CXR, echocardiography and PFTs, should depend on the patient’s ASA grade, comorbidities and the complexity of the surgery • Optimisation of their modifiable risk factors, e.g. smoking cessation | |