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Scheduling Elective Surgery After COVID-19

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

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 guidelines suggest the longer a patient waits after testing positive for COVID-19 the better the expected outcome for the patient. These timelines should not be considered definitive as each patient’s risk assessment should be individualized. The wait times below are suggested 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: 

  • 4 weeks: Asymptomatic patient or patient with mild, non-respiratory symptoms 
  • Patients may be placed on the schedule no less than 28 days after the start of symptoms or the date of the swab that resulted in a positive test. 
  • 6 weeks: Symptomatic patient that did not require hospitalization 
  • Patients may be placed on the schedule no less than 42 days after the start of symptoms or date of the swab that resulted in a positive test.  
  • 8-10 weeks: Symptomatic patient that required hospitalization or a patient that has significant co-morbidities, i.e. diabetic, immunocompromised. 
  • Patients may be placed on the schedule no less 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.  
  • 12 weeks: Symptomatic patient that required ICU admission 
  • Patients may be placed on the schedule no less than 84 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. 

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: 

  1. 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.   
  1. 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 in MatchMD. 
  1. 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 patient should be postponed. Patients should be notified by the office surgery scheduler.  
  1. What if the procedure is urgent, emergent, or already an inpatient? 
    Those cases will be performed as needed.   
  1. 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.   
January 5, 2021