Pre-Procedural Screening and Testing During COVID-19
Updated April 2, 2021: Throughout the pandemic, surgeons have faced many challenges in adapting to new situations. Now that facilities have resumed elective surgeries, surgeons are facing additional challenges in evaluating and scheduling patients who have recovered from COVID-19. The strategies highlighted here can help ensure a consistent approach in keeping both patients and providers safe.
A new international study suggests that “when possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection and that patients with ongoing symptoms at ≥7 weeks from diagnosis may benefit from further delay.”1
For patients with known or suspected prior infection, the American Society of Anesthesiologists (ASA) and the Anesthesia Patient Safety Foundation (APSF) released the “ASA and ASPF Joint Statement on Elective Surgery and Anesthesia for Patients after COVID-19 Infection” (updated March 9, 2021) to guide perioperative decision making and care. The statement includes the following suggested wait times from the date of COVID-19 diagnosis to the date of elective surgery:
- Four weeks for an asymptomatic patient or recovery from only mild, nonrespiratory symptoms.
- Six weeks for a symptomatic patient (e.g., cough, dyspnea) who did not require hospitalization.
- Eight to 10 weeks for a symptomatic patient who is diabetic, immunocompromised, or hospitalized.
- Twelve weeks for a patient who was admitted to an intensive care unit due to COVID-19 infection.
We encourage you to stay current with the latest recommendations from the Centers for Disease Control and Prevention (CDC) and your specialty organizations, including the ASA and the American College of Surgeons, on clinical issues and guidance for COVID-19. For preprocedural testing recommendations, see the “ASA and APSF Joint Statement on Perioperative Testing for the COVID-19 Virus” and the ASA frequently asked questions on “COVID-19 and Patient Testing.”
As the CDC and other professional organizations revise their recommendations, the facilities where you practice may have also changed their policies and testing recommendations. It is important to review the current policies for perioperative COVID-19 testing where you practice as protocols continue to evolve.
The following example might help you inform patients about why you need to ask additional questions or require more testing:
“COVID-19 is an extremely contagious virus believed to be spread by person-to-person contact. For your safety as well as the safety of our own team members and other patients, we will be gathering additional information to better assess your risk of becoming infected by COVID-19 during your surgical episode.”
Consider offering the following preprocedural instructions (even with patients who have recovered from COVID-19 or have been fully vaccinated):
- You will be tested prior to your elective procedure and asked to isolate until your surgery. Should you test positive, your procedure will be postponed until you have fully recovered and test negative.
- If you had COVID-19, have recovered, and have since tested negative, please bring those results with you the day of your procedure. We may opt to retest you prior to the day of surgery.
- If you are fully vaccinated, please bring your proof of vaccination. You will still be asked screening questions and be tested prior to surgery as it remains unclear if vaccinated patients without any symptoms can be carriers of COVID-19.
- Isolate prior to the procedure to protect yourself from potential exposure to COVID-19. If you have not isolated, or if you or your close family members work or volunteer in high-risk areas, such as a medical facility or in an occupation that requires interaction with many individuals in close proximity, please contact us so we can determine your risk of exposure.
- Continue to follow physical distancing, masking, and handwashing guidelines even after vaccination or recovering from COVID-19. This applies to the person who will be bringing you to and from our facility as well.
- Check for the following symptoms each day until your procedure and notify us immediately if they occur:
- Fever above 100.5°F that lasts 24 hours.
- New respiratory symptoms, such as cough, shortness of breath, sore throat, etc.
- Loss of smell or taste.
An important part of each patient’s recovery involves emotional and mental health—which often includes maintaining close physical relationships with family members. Consider making the following inquiries to determine the patient’s post-discharge risk for exposure to COVID-19:
- Obtain the name and contact information of the adult who will be in attendance during surgery and will drive the patient home. Advise the patient’s contact of the screening protocols that will be required for visitation.
- Discuss the discharge plan with the patient. Consider asking these questions to ensure that appropriate shelter-in-place and social distancing requirements can be followed:
- Will you be recovering in your home or at another location (family member or friend)?
- How many individual(s) will be assisting you with your recovery at home?
- Are any of the individuals who will be assisting with your recovery working or volunteering in a high-risk area, such as a medical facility, or do any of those individuals work as a police officer, a firefighter, or in an occupation or volunteer position with close proximity to a large number of people?
- How many individuals currently live in your recovery location?
- How many visitors do you anticipate having?
- Will you have someone who can pick up prescriptions and groceries for you? (If not, have the patient provide details for a local pharmacy that can deliver medications.)
- Remind the patient to visit the grocery store before surgery so no shopping will be required during the week after surgery.
- Ask the patient about the availability of home technology (e.g., a computer or cell phone) for a telehealth post-op visit. If possible, as part of pre-op preparations, test the application after downloading so your staff can ensure it is available for post-op communication.
History is a limited guide to COVID-19, and the process is challenging because of insufficient uniformity and rational benchmarking. Through it all, however, we are slowly winning the battle—we see this clearly because of the great work our doctors, nurses, and hospitals are doing under crisis conditions. The Doctors Company is providing this assessment to support you and respond to your needs—and those of your patients.
- COVIDSurg Collaborative and GlobalSurg Collaborative. Timing of surgery following SARS-CoV-2 infection. Anaesthesia 2021. doi:10.1111/anae.15458
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.