The Royal College of Anaesthetists, the Association of Anaesthetists, the Faculty of Intensive Care Medicine and the Faculty of Pain Medicine have received queries about how to manage patients presenting for planned surgery with respect to preoperative testing and self-isolation, and how long patients who have had COVID-19 should wait before undergoing surgery. Guidance on these issues has changed recently, and we wish to ensure that our members are aware of the latest information available.
There is no longer an absolute need for pre-operative PCR testing or self-isolation for three days or more for every patient undergoing planned surgery: fully vaccinated patients (currently three doses or more) who are asymptomatic and ‘low risk’ (see below) need only a negative lateral flow test (LFT) on the day of surgery, and do not need to self-isolate. UKHSA guidance on this is here and the government press release on the change is here.
A recently published multidisciplinary consensus statement updated and superseded previous guidance, which was based on data from pre-Omicron variants. Both documents note that risk of surgery may be increased within seven weeks after SARS-CoV-2 infection, but the new document recommends balancing the benefits of a seven-week delay against the risks. The guidance provides information on what constitutes low-risk patients, which we interpret as: ASA Physical Status one or two patients aged less than 70 years who had only minor COVID-19 symptoms and have recovered fully from the infection who are scheduled to undergo minor, planned body surface or extremity surgery or most outpatient eye surgery. However, even low-risk patients should not undergo planned surgery within 10 days of the diagnosis of SARS-CoV-2 infection, as they may still be infectious, and the illness may not have run its full clinical course. Whether to defer surgery for the seven-week period after COVID-19 diagnosis is a shared decision to be made by the patient, the surgeon and – when appropriate – the anaesthetist. It is important to note that some patients with ongoing health problems resulting from COVID-19 may need to wait for more than seven weeks before undergoing planned surgery.
Patients who fall outside of this definition of ‘low risk’ may still undergo surgery within seven weeks of infection after a multidisciplinary discussion that takes a pragmatic view of risk and benefit, having considered such factors as formal risk scores, patient age and comorbidities, surgical priority, risk of disease progression and the complexity of the surgery. Communication with the patient is key to discussions around risk, and the guidance provides a valuable risk communication tool.
Royal College of Anaesthetists, Vice President
The Association of Anaesthetists, President
Faculty of Intensive Care Medicine, Dean
Faculty of Pain Medicine, Dean