Originally published by our sister publication, Anesthesiology News
Delaying elective surgery for 10 days after COVID-19 symptoms first appear or after the first positive test for the infection has been working well since December 2021. However, a new study recommends that asymptomatic patients also should still wait to undergo such procedures (Br J Anaesth 2022;128[5]:e311-e314).
“This decision is based on data that suggests that by day 10, the patient is no longer infectious and therefore not in a condition to put healthcare personnel at risk, nor does the patient seem to be at risk for poor outcomes,” said lead investigator Matthias Eikermann, MD, PhD, the chair of anesthesiology at Montefiore Health System (MHS), in New York City.
The idea for the study emerged during the highly infectious fourth surge (December 2021 to present) of the pandemic, “where the staff of many New York City hospitals, including ours, were impacted quite severely,” Eikermann said. “The question came up at a meeting of our hospital executive command team as to how to define the criteria for safe elective surgery during a period of rising numbers of patients presenting with a SARS-CoV-2–positive test.”
The command team discussed recommendations from the national societies of anesthesiology and surgery, “which appeared not to apply to the patients we were treating,” Eikermann said. “We had heard about the more benign omicron variant, but it was surprising to us to see that the clinical presentation was so different between surge 1 and 3 and during 4.”
COVID-19: Down but Not Out
In early 2022, COVID-19 pneumonia was almost eliminated: down to 0.2% of emergency department visits at MHS in New York City and Westchester County, New York. However, during previous surges, March 2020 to November 2021, 33.6% of the 7,872 hospitalized patients at MHS with positive polymerase chain reaction tests lost their ability to live independently and 18.4% died in the hospital.
“By contrast, during the fourth surge, which resulted in 538 hospitalizations, 10.4% of patients were admitted to a nursing home and 5.2% died in the hospital,” Eikermann said.
Data describing poor outcomes of patients with COVID-19 obtained during the first surge, when elective surgery was initially canceled, “cannot be applied to our current scenario,” said Eikermann, a professor of anesthesiology at Albert Einstein College of Medicine, in New York City.
“There is no evidence to suggest that after positive COVID-19 tests in 2022, the risk of elective surgery is increased. But the risks of virus transmission still exist.”
Although each patient for elective surgery at MHS has a comprehensive preoperative evaluation, “a shortening of the time could expose vulnerable patients and staff members to the risk of COVID-19 infection,” Eikermann said.
Also, as new COVID-19 strains emerge, recommendations may need to be modified, based on transmissibility and virulence.
Eikermann and his co-authors are evaluating whether patients with positive COVID-19 tests have an increased risk for subtler adverse signs and symptoms, such as post-op neurocognitive disorders like delirium, anxiety and depression.
Douglas Colquhoun, MB, ChB, an assistant professor of anesthesiology at the University of Michigan, in Ann Arbor, said the study does not “directly assess the impact of COVID-19 infection on surgical patients across the pandemic surges. The changing profile of mortality and severe outcomes in the general population is, however, interesting.”
Guidance from the CDC might help hospitals consider periods when risk for transmission from patients to healthcare workers is likely, according to Colquhoun, who was not a study author. “However, further data is required to help refine our understanding of risk to surgical patients of proceeding after a recent infection,” he said.
—Bob Kronemyer
Colquhoun reported funding from the National Institutes of Health for research in pulmonary outcomes after surgery. Eikermann reported no relevant financial disclosures.