Surgery with/post covid infection

[anbuitachi]

I think this was discussed a while ago but i cant find it. From a non financial point of view and more of a ethical/what's best for the patient. What are you doing for elective cases for patient who tested positive or recently tested positive? Unless this was recently changed, ASA/APSF released joint guideline ages ago recommending delay in order of weeks

My hospital has a policy of putting covid patients on schedule for surgery only after 10 days after positive test, and 72 hours being asymptomatic.

However this goes directly against ASA/APSF guidelines. This situation kind of feels like if my hospitals NPO policy went against ASA guidelines. Imagine hospital telling patients they can eat full meals up to 2 hours before surgery.

Just to be clear i have no doubt i can get the patient thru surgery so I am not concerned about that. But studies do show way higher mortality post surgery in recent covid+.

"In patients who had been asymptomatic with COVID-19, odds of 30 day mortality after surgery performed within seven weeks of the diagnosis were also increased, but to a lesser extent than patients who had been symptomatic. For surgery performed at zero to two, two to four, and five to six weeks after diagnosis odds ratios were 3.94 (95% CI 2.71-5.17), 3.57 (95% CI 1.96-5.17, and 3.26 (95% CI 1.45-5.07), respectively."

Some have said, just explain to patient the risks, which i guess is one way of doing it. but at the same time if patient showing up for a inguinal hernia ate 2 steaks a hour before surgery, I'm not telling them the risk of aspiration and proceeding... I'm postponing the case

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[Blockit]

I have been using that very same guideline.

 

[Volatile]

We mostly use ASA/APSF guidelines. Although we generally reschedule patients who have a cough but don’t require hospitalization at 4 weeks instead of 6. We also never re-test these patients inside of 90 days. The patient can be scheduled sooner if it’s a time sensitive surgery as long as patient understands risk. It’s not a perfect system but works well enough for us

 

[BLADEMDA]

The guidelines apply to Delta not Omicron. I want to push back some on the times. Asymptomatic infection, tests positive, with 3 shots I would say 2 weeks would be just fine. Mild symptoms I would use 4 weeks. Severe Symptoms without hospitalization 6 weeks.

Just like 10 days of quarantine has been shortened to 5-7 days, these other times need to be reduced as well for Omciron.

 

[GassYous]

Elective is elective
They can get it done in 6 weeks
I don't get anything out of it being earlier

 

[Guillemot]

The ASPF guidelines are still extant AFAIK, and they were cited by an article puplished in the ASA monitor about surgery after COVID: I'm in It for the Long Haul: Anesthetic Implications of Elective Surgery in the COVID-Recovered Patient | ASA Monitor | American Society of Anesthesiologists


The situation is constantly changing though. Eg. Does a triple vaccinated asymptomatic patient really need to be delayed a month? I don't know if there is evidence to support that.

 

[Guillemot]

Here also is a recent thread with practical advice about what action you should take with a patient who recently had COVID: Experiences with angry general surgeons tipping into impairment?

 

[NICMAN]

Did the hospital actually ask the clinical stakeholders to comment prior to the policy being put into place? Did they just ask the sports medicine Ortho pods what they thought was adequate so that their schedule was minimally affected?

This policy (similar to what Volatile described) has been our policy for over a year. Perhaps we should shorten the asymptomatic time-delay but what’s next, 5 days?

Also, almost every single hospital bylaw statement contains a bylaw that says that a physician shall not be forced to perform a procedure or prescribe a treatment against their own medical judgement. Anesthesiologist in your group can’t be forced to practice according to rink-y-dink hospital policies that go against current national society clinical guidelines.

 

[GassYous]

The ASPF guidelines are still extant AFAIK, and they were cited by an article puplished in the ASA monitor about surgery after COVID: I'm in It for the Long Haul: Anesthetic Implications of Elective Surgery in the COVID-Recovered Patient | ASA Monitor | American Society of Anesthesiologists


The situation is constantly changing though. Eg. Does a triple vaccinated asymptomatic patient really need to be delayed a month? I don't know if there is evidence to support that.

Real question is does this elective procedure need to go right now to the or

 

[Arch Guillotti]

I think this was discussed a while ago but i cant find it. From a non financial point of view and more of a ethical/what's best for the patient. What are you doing for elective cases for patient who tested positive or recently tested positive? Unless this was recently changed, ASA/APSF released joint guideline ages ago recommending delay in order of weeks

View attachment 348022

My hospital has a policy of putting covid patients on schedule for surgery only after 10 days after positive test, and 72 hours being asymptomatic.

However this goes directly against ASA/APSF guidelines. This situation kind of feels like if my hospitals NPO policy went against ASA guidelines. Imagine hospital telling patients they can eat full meals up to 2 hours before surgery.

Just to be clear i have no doubt i can get the patient thru surgery so I am not concerned about that. But studies do show way higher mortality post surgery in recent covid+.

"In patients who had been asymptomatic with COVID-19, odds of 30 day mortality after surgery performed within seven weeks of the diagnosis were also increased, but to a lesser extent than patients who had been symptomatic. For surgery performed at zero to two, two to four, and five to six weeks after diagnosis odds ratios were 3.94 (95% CI 2.71-5.17), 3.57 (95% CI 1.96-5.17, and 3.26 (95% CI 1.45-5.07), respectively."

Some have said, just explain to patient the risks, which i guess is one way of doing it. but at the same time if patient showing up for a inguinal hernia ate 2 steaks a hour before surgery, I'm not telling them the risk of aspiration and proceeding... I'm postponing the case

Why isn’t your department involved in the process?

 

[anesthesiadoc]

There is a great course on the ASA website’s learning center that gives a review of literature and current recs for timing surgery around Covid.

 

[anbuitachi]

The guidelines apply to Delta not Omicron. I want to push back some on the times. Asymptomatic infection, tests positive, with 3 shots I would say 2 weeks would be just fine. Mild symptoms I would use 4 weeks. Severe Symptoms without hospitalization 6 weeks.

Just like 10 days of quarantine has been shortened to 5-7 days, these other times need to be reduced as well for Omciron.

i dont think the quarantine shortening was based on medical science.. more like short staffing

 

[anbuitachi]

Real question is does this elective procedure need to go right now to the or

thats going to vary a lot based on who you ask. like when covid started , and elective surgeries were halted, including stuff like cataracts etc. now elective cases are also halted, but hospital redefined what elective surgeries mean, and it pretty much only applies to purely cosmetic cases that can for sure wait, which we rarely did anyway at our hospital. so its fairly unchanged since we paused elective surgeries this time.

 

[anbuitachi]

Why isn’t your department involved in the process?

they may be, but im not the boss so i have no idea

they technically didnt say anesthesiologist must do the case or anything like that. but if all these patients get put on the schedule, we will be cancelling a good # of cases

 

[coffeebythelake]

The guidelines apply to Delta not Omicron. I want to push back some on the times. Asymptomatic infection, tests positive, with 3 shots I would say 2 weeks would be just fine. Mild symptoms I would use 4 weeks. Severe Symptoms without hospitalization 6 weeks.

Just like 10 days of quarantine has been shortened to 5-7 days, these other times need to be reduced as well for Omciron.

And how will you tell whether the patient has delta or omicron based on q covid swab?

 

[narcotics999]

And how will you tell whether the patient has delta or omicron based on q covid swab?

CDC says 95% new cases are omicron. So not delta anymore if you believe CDC.

 

[nimbus]

No different than guidelines after nstemi or stemi.