Leading medical organisations publish new surgery guidance for the one in five patients who have had COVID
Guide lets patients know when to wait for surgery, as studies suggest 10-fold increase in death for adults with an active COVID infection
New standards will strive to make surgery as safe as possible
In a new guide published today in the journal Anaesthesia, a leading group of professional medical organisations are calling for the NHS to use new standards to manage surgical patients who have previously had COVID. The guidance produced by the Centre for Perioperative Care, the Royal College of Anaesthetists, the Royal College of Surgeons of England, the Association of Anaesthetists and the Federation of Surgical Specialty Associations advises patients to wait or risk higher mortality rates.
An estimated 15-20% of UK adults have contracted COVID during the pandemic. As the NHS begins to tackle the backlog of surgery, this guide will help inform the decisions of those patients who need an operation in the near to medium-term future.
With some studies suggesting a 10-fold increase in death for adults having an operation1 around the time of getting an active COVID infection, compared with non-COVID patients. It is vital that this group of patients receives surgery that is as safe as possible and appropriate for them.
The guidance is informed by academic studies and the latest data from the COVIDSurg group2.
Key Guidance points:
- Emergency surgery, even for a patient without COVID symptoms should proceed with full COVID precautions.
- For elective or planned surgery, a delay of seven weeks after infection is recommended, including for people who are otherwise asymptomatic (but have had a positive test).
- There should be an individual assessment and longer preparation time for COVID patients who have recently been treated with steroids or who have had on-going or previously severe COVID symptoms.
- Timing of surgery following a COVID infection should involve shared decision-making between the patient and their healthcare team – this includes discussions about the risks and benefits of operating, alternatives to surgery, and doing nothing. This is particularly important as the health of many patients may have deteriorated during the pandemic
- All patients should use the time before their surgery to better prepare for their procedure, e.g. by gradually improving their fitness or by stopping smoking, as this greatly reduces complications after operations, especially if they have other medical problems. It is important that we change the patient’s perception, so they see this period not as waiting time but preparation time.
Mrs Scarlett McNally, Deputy Director of the Centre for Perioperative Care (CPOC) and Consultant Orthopaedic surgeon said:
“This guidance is invaluable for the teams trying to plan care. One in ten patients with COVID will need specialised input and the guide is clear on who this affects. For all patients, we need to move towards a model where ‘waiting lists’ for surgery become ‘preparation lists’ – where patients use this time to get as fit as possible for their surgery.
“Evidence shows that simple interventions such as a daily walk, practicing sit-to-stand exercises and having medication reviewed can reduce complications by between 30%-80%. Patients who have had COVID have been through enough – we now need to help empower them through shared-decision making and making best use of their waiting period to have the best possible outcome following their surgery.”
Dr Kariem El-Boghdadly, Consultant Anaesthetist and lead clinician for the guidance:
“We have a growing number of patients that need surgical care and a growing number of patients who have had COVID-19. What we wanted to do is ensure that these patients receive the safest surgical care possible in the face of previous COVID-19 infection. We need to get through the NHS waiting lists as safely as we can and we hope this new guidance will help us achieve that for all our patients.”
Read the full guidelines here: doi.org/10.1111/anae.15464
Access a patient-facing resource here: www.cpoc.org.uk/patients
- Delaying surgery for patients with a previous SARS-CoV-2 infection. British Journal of Surgery 2020; 107: e601–e602.
- CovidSurg was a platform of studies aiming to explore the impact of COVID-19 in surgical cases and services. It can be accessed here: https://globalsurg.org/covidsurg/