It is now clear that the ongoing effects of COVID-19 can affect your health in many ways, including how your body reacts to surgery.
In this case, the changes are significant, as an increasing number of studies have shown a significant increase in the risk of death after surgery and pulmonary complications for at least six weeks after symptomatic and asymptomatic COVID-19 infection.
No surgery is without risks, and surgeons always weigh the risks against the benefits of performing a particular procedure on a particular patient.
These findings about the relationship between “Covid-19” infection and surgical complications and deaths add new variables to the equation, and hospitals and health systems across the country are adopting new policies to keep patients as safe as possible.
A new policy at Yale New Haven Health now states that elective surgeries for adult patients that require general or axonal anesthesia (anesthetic placed around the nerves) must be postponed seven weeks from the time of known “Covid-19” diagnosis.
In addition, elective surgeries for adults who are immunocompromised, diabetic or have a history of hospitalization should be postponed eight to 10 weeks after diagnosis. Those with a history of hospitalization in intensive care should be deferred for 12 weeks.
Surgeons are advised to discuss the risks of surgery with the patient early on, says Nita Ahuja, MD, MBA, chief of surgery for Yale Medicine and chief of surgery at Yale New Haven Health. She adds that these guidelines do not apply to urgent and emergency surgery.
Several small studies, including one published in The Lancet, have suggested that patients who test positive for COVID-19 may have worse outcomes and an increased chance of dying after surgery. A large international study, published in the journal Anesthesia, showed that keeping surgery on hold for at least seven weeks after a positive coronavirus test was associated with a lower mortality risk compared to no delay.
The most recent study on this topic was published in JAMA Network Open last April and compared 5,470 surgical patients with positive “Covid-19” test results (within six weeks) to 5,470 patients with negative results.
There were more than double the number of reported deaths in the COVID-19 positive group versus the negative group.
Although surgeons are well aware of these guidelines, it is important for patients and their family members to understand the reasoning behind the decision to postpone surgery, even for someone who is feeling well. “We want to provide this information to patients so they can have a discussion with surgeons and providers,” says Roberta Haynes, chair of anesthesiology at Yale Medicine. “Every decision needs to be made on an individual level, and we want to ensure that the patient is an active participant in their care.”
For example, a patient with cancer may want surgery as soon as possible.
For some, the risks of waiting for surgery may be greater than delaying it, while for others it may be smarter to wait. Each situation is different and what to do in a particular case is a decision that must be taken jointly by the patient and the surgeon.
Emergency surgeries will continue to be performed “to save lives or limbs” as needed. However, Dr. Ahuja says: “Semi-elective surgery represents the majority of our cases, especially in relation to cancer care. These are surgeries that do not need to be done immediately, but there is a certain period of time. However, when someone comes to the hospital after a car accident, they will not We are delaying the surgery because he was infected with the Corona virus.”
All patients should have a COVID-19 test (polymerase chain reaction, the most reliable of the different types of tests available) prior to surgery.
That won’t change, says Dr. Ahuja, which is key to catching an active (not previous) infection that patients never knew they had.
The relationship between COVID-19 infection and surgical complications appears to make sense given how research indicates a link between COVID-19 infection and inflammation.
“Plus, the infection creates an inflammatory state in the body, and this can last for at least six weeks,” Dr. Ahuja explains. That is why we recommend postponing surgery for at least six weeks after diagnosis.
And it’s not just surgery, but anesthesia that can exacerbate inflammation in the body, notes Dr. Haynes.
Source: Medical Express