In a joint statement, the American Society of Anesthesiologists (ASA) and Anesthesia Patient Safety Foundation (APSF) have released updated recommendations for the timing of elective surgery for patients after recent COVID-19 infection.

Elective procedures should be performed only after a patient has clinically recovered from COVID-19 and an agreement to proceed is reached between the anesthesiologist, surgeon and patient, according to the new guidance. The decision to proceed with surgery also should be based on whether the patient is infectious. The ideal time to wait between patient recovery from COVID-19 and the surgical procedure, based on healthcare professionals’ opinions, also should be considered.

“While the federal COVID-19 Public Health Emergency has ended, patients are still getting infected with the virus, which has presented challenges in optimally scheduling elective surgeries safely,” said Michael W. Champeau, MD, FAAP, FASA, the president of the ASA. “In light of recent studies, ASA and APSF have been working with our British colleagues to assess and align our recommendations for scheduling a procedure after a patient has had COVID-19. As the disease evolves and becomes less virulent and increasing numbers of the population have either been vaccinated, exposed or both, these recommendations help provide guidance on balancing the risk of delaying surgery against the risk of complications.”

The updated recommendations include the following:

     • Patients who have COVID-19–type symptoms should be screened and, if appropriate, tested before undergoing an elective procedure. Physicians should consider the timing and symptoms of the infection to determine when patients are no longer infectious.
     • Elective surgeries should not occur within two weeks of a COVID-19 infection, allowing anesthesiologists and surgeons to assess how severe the patient’s symptoms are and to reduce unnecessary risk for transmitting the infection to healthcare professionals.
     • Between two and seven weeks after the patient’s COVID-19 infection, the physicians should conduct a risk assessment for that patient, including factors such as their age, severity of the infection and surgical risk.
     • If the patient and surgery are determined to be low risk, the anesthesiologist and surgeon should discuss scheduling the procedure with the patient between two and seven weeks after infection. That decision should consider whether the risk for proceeding exceeds the risk for delay.
     • Delay of the surgery beyond seven weeks should be considered if the patient continues to have symptoms.
     • Facilities, surgeons and anesthesiologists should track patient outcomes of elective surgery after COVID-19, including complications and mortality.

The significance of COVID-19 and impact it has on individuals are not diminished by the newly revised recommendations.

“Our recommendations have evolved as the data has changed and are the most up-to-date guidance in the best interests of high-quality, safe patient care,” said Daniel J. Cole, MD, FASA, the president of the APSF.

By Landon Gray