Delay Surgery 7 Weeks After COVID-19 Infection for Unvaccinated

Elective surgical procedures should be delayed at least 7 weeks after COVID-19 infection in unvaccinated patients, according to new joint statement issued by the American Society of Anesthesiologists and the Anesthesia Patient Safety Foundation (APSF).

Dr Randall Clark

For patients fully vaccinated against COVID-19 with breakthrough infections, there is no consensus on how vaccination affects the time between COVID-19 infection and elective surgery. Clinicians should use their clinical judgement to schedule procedures, said Randall M. Clark, MD, president of the American Society of Anesthesiologists (ASA). "We need all physicians, anesthesiologists, surgeons, and others to base their decision to go ahead with elective surgery on the patient's symptoms, their need for the procedure, and whether delays could cause other problems with their health," he told Medscape Medical News.

Prior to these updated recommendations, which were published February 22, the ASA and the APSF recommended a 4-week gap between COVID-19 diagnosis and elective surgery for asymptomatic or mild cases, regardless of a patient's vaccination status.

Extending the wait time from 4 to 7 weeks was based on a multination study conducted in October 2020 following more than 140,000 surgical patients. Patients with previous COVID-19 infection had an increased risk for complications and death in elective surgery for up to 6 weeks following their diagnosis, compared with patients without COVID-19. Additional research in the US found that patients with a preoperative COVID diagnosis were at higher risk for postoperative complications of respiratory failure for up to 4 weeks after diagnosis and postoperative pneumonia complications for up to 8 weeks after diagnosis.

Because these studies were conducted in unvaccinated populations or those with low vaccination rates, and preliminary data suggest vaccinated patients with breakthrough infections may have a lower risk for complications and death post-infection, "We felt that it was prudent to just make recommendations specific to unvaccinated patients," Clark added.

Dr Brent Matthews

Although this guidance is "very helpful" in that it summarizes the currently available research to give evidence-based recommendations, the 7-week wait time is a "very conservative estimate," Brent Matthews, MD, surgeon-in-chief of the surgery care division of Atrium Health in Charlotte, North Carolina, told Medscape. At Atrium Health, surgery is scheduled at least 21 days after a patient's COVID-19 diagnosis, regardless of their vaccination status, Matthews said.

The studies currently available were conducted earlier in the pandemic, when a different variant was prevalent, Matthews explained. The Omicron variant is currently the most prevalent COVID-19 variant and is less virulent than earlier strains of the virus. The joint statement does note that there is currently "no robust data" on patients infected with the Delta or Omicron variants of COVID-19, and that "[T]he omicron variant causes less severe disease and is more likely to reside in the oro- and nasopharynx without infiltration and damage to the lungs."

Still, the new recommendations are a reminder to reevaluate the potential complications from surgery for previously infected patients, and consider what comorbidities might make them more vulnerable, Matthews said. "The real power of the joint statement is to get people to ensure that they make an assessment of every patient that comes in front of them who has had a recent positive COVID test."

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