22/05/2021
Waiting for Surgery ...read the following... Be informed, choose wisely...
*Surgery after Covid*
High Risk of infection to Surgical team and High Mortality in Patient..
*Suggested waiting times from the date of COVID-19 diagnosis to surgery* # :
1️⃣. *Four weeks for an asymptomatic* patient or recovery from only mild, non-respiratory symptoms.
2️⃣.Six to *seven weeks for a mild symptomatic* patient (e.g., cough, dyspnea) who did not require hospitalization.
3️⃣.Eight to *10 weeks for a moderate* symptomatic patient who is diabetic, immunocompromised, or hospitalized.
4️⃣. *Twelve weeks for a patient who was admitted to ICU* intensive care unit due to COVID-19 infection.
Note : These *timelines should not be considered definitive*; each patient’s preoperative risk assessment should be individualized, factoring in surgical intensity, co-morbidities, and the benefit/risk ratio of further delaying surgery.
‼️ *PAC in Post Covid patients*:
A thorough *preoperative evaluation*, with special attention given *to the cardiopulmonary systems*,
🌹 *Evidence in favour of guidelines*:🌹
An international, multicentre, prospective *study of 140,231 patients undergoing surgery in 116 countries* during pandemic including AIIMS. Published in _Anaesthesia_
30 day post operative mortality compared in patients with pre-operative SARS-CoV-2 infection with those without previous covid.
‼️ *30 day post surgical mortality in patients with no evidence of pre op covid was1.5%. It increased to two and half time (4%)when patients were operated within 6 wks of mild covid but remaimed at 1.5% if patients were operated at 7-8 wks after SARS-CoV-2 diagnosis*. ‼️
*Further Delay beyond 7 weeks in cases of persistent post-covid symptoms*
patients who are still symptomatic seven weeks after SARS-CoV-2 infection and undergo surgery, have an increased mortality rate.
Such patients may benefit from a further delay until their symptoms resolve.
Q *When should RTPCR be done before surgery?*
A: In non admitted patients testing is advised *within 96 hours before surgery*. After testing patient should be instructed to limit their social interactions to their own household given the as short as 2 day incubation period of COVID-19 after exposure.
Q. *Can we accept a COVID-19 test done 96 or more hours before surgery?*
A: Since the incubation period (time from exposure to symptoms) is as short as 2 days with COVID-19, the clinician should ask the family if they have limited their contact with their own household. If not, please retest.
Q: *How long is a negative test good in admitted patients?*
A Admitted patients who tested negative for COVID on admission do not need to be retested unless the patient develops new symptoms of COVID-19 or worsening conditions.
# ASA-APSF Joint Statement on Elective Surgery and Anesthesia.
