Unfortunately, Covid-19 is part of our daily lives and we continue to learn to live with it. Recently the Australian and New Zealand College of Anaesthetists published the “Living guidance: Surgical patient safety in relation to COVID-19 infection and vaccination”. This document aims to guide best practise to minimise patient risk and to optimise outcomes in patients having elective surgical procedures following infection or vaccination.
Recommendations
Timing of elective surgery after infection
The urgency of the required surgery and the possible risks associated with recent infection need to be carefully evaluated. It is believed that peri-operative risk has returned to baseline after 7 weeks post infection. It is recommended that non-urgent major elective surgery be postponed for eight weeks post infection and minor elective surgery be postponed for four weeks.
Infection in vaccinated patients
Fully vaccinated patients with mild symptomatic or asymptomatic breakthrough infection may be treated like patients requiring deferral after any acute respiratory illness. Those with more symptomatic disease should be treated along the lines of those unvaccinated patients post Covid-19 infection.
Repeat testing
The CDC does not recommend re-testing with in 90 days of a test positive confirmed case of Covid-19 infection because persistent positive tests are common during this time after recovery. This is likely due to shedding of viral fragments. Shedding can occur for up to a month or more post infection. If during the 90 day recovery period a patient presents with a recurrence of infection, then repeat PCR testing in consultation with an infectious diseases specialist is advised.
Optimisation post infection prior to elective surgery
Patients should as part of their pre-operative assessment have a clinical review of the state of their cardiorespiratory system, haematological system, neurology (cognition and fatigue) and mental well-being. Those patients that had significant symptoms should be considered to have formal investigations including cardiac assessment and CXR or CT chest. There is considered an increased risk of thrombosis (DVT/PE) after infection with Covid-19 and suitable prophylaxis should be employed for any elective surgery.
Surgical patients and Covid-19 vaccines
Full vaccination prior to surgery is recommended. If time is constrained then partial vaccination may still be of benefit. Advice on the timing of vaccination before surgery is variable. To avoid confusion between vaccine side effects and possible symptoms of surgical complications it is recommended a minimum of 1 week between vaccination and surgery. To ensure optimal immune response from vaccination and time permits then having at least 2 weeks after vaccination before surgery if preferable.