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Scheduling Elective Surgery after COVID-19 Infection

The American Society of Anesthesiologists (ASA) and the Anesthesia Patient Safety Foundation (APSF) have recently issued a joint statement on elective surgery for patients after a positive COVID-19 infection.  Link follows: 

https://www.asahq.org/about-asa/newsroom/news-releases/2020/12/asa-and-apsf-joint-statement-on-elective-surgery-and-anesthesia-for-patients-after-covid-19-infection

The ASA/APSF guidance suggests that the longer a patient waits after testing positive for COVID-19, the better the expected outcome is for the patient. These timelines should not be considered definitive, as each patient’s risk assessment should be individualized. Effective January 4, please use the suggested wait times below to decrease the risk of cardiopulmonary complications associated with COVID-19 and elective surgical and other procedures. The surgeon/proceduralist and the anesthesiologist should jointly agree to proceed, prior to the procedure, if the following guidelines are not met.     

  1. 4 weeks:  Asymptomatic patient or patient with mild, non-respiratory symptoms. 

Patients may be placed on the schedule no fewer than 28 days after the start of symptoms or the date of the swab that resulted in a positive test. 

  1. 6 weeks:  Symptomatic patient who did not require hospitalization. 

Patients may be placed on the schedule no fewer than 42 days after the start of symptoms or date of the swab that resulted in a positive test.  

  1. 8-10 weeks:  Symptomatic patient who required hospitalization or a patient who has significant co-morbidities (i.e., diabetic, immunocompromised). 

Patients may be placed on the schedule no fewer than 56 days after the start of symptoms or the date of the swab that resulted in a positive test and must not be in the hospital at the time of scheduling.  

  1. 12 weeks:  Symptomatic patient who required ICU admission. 

Patients may be placed on the schedule no fewer than 84 days after the start of symptoms or the date of the swab that resulted in a positive test, and must not be hospitalized at the time of scheduling. 

Urgent, emergent, and time-sensitive cases will proceed as necessary. Elective procedures scheduled before the suggested time has elapsed require a conversation between the surgeon/proceduralist and the anesthesiologist and should occur prior to the procedure being scheduled. All appeals will be reviewed by the PSEC.   

Frequently Asked Questions 

What if the proceduralist believes that a delay in care will negatively impact the care of the patient?  Before scheduling the procedure, contact an anesthesia provider to discuss any potential negative impacts that should be considered if care is delayed.  Each patient deserves individualized care.   

How do I reach an anesthesiologist to discuss the procedure? All calls should be referred to the anesthesia provider on call for that facility for the day. The call schedule is located in MatchMD. 

What if the procedure is already on the schedule? Office surgery scheduling staff should review the patient chart to see when the patient developed symptoms or was positive and compare that to the date of the procedure. If the appropriate time has not passed, the procedure should be postponed. Patients should be notified by the office surgery scheduler.  

What if the procedure is urgent, emergent or already an inpatient? Those cases will be performed as needed.   

If a patient is an inpatient, how many hours prior to the procedure requiring anesthesia should a COVID-19 test be performed? The test needs to be done no more than 72 hours prior to surgery in order to be resulted and on the chart prior to the procedure.   

Scripting in the event of case postponement 

Kettering Health Network and your health care team are concerned with your safety and well-being, as well as the safety and well-being of our community. Because of recent increases in COVID-19 cases in our community, it is essential that we take additional steps to prepare our hospitals and assist our caregivers in delivering the best and safest care possible to our patients. After careful review of current trends, we will be delaying some elective procedures on patients who tested positive that can safely be postponed.  If your condition changes, please contact your provider or visit a Kettering Health Network emergency department, if warranted. We appreciate your patience, understanding and partnership as we each do our part to keep our community safe.  

December 23, 2020