COVID-19 is still delaying surgeries, even as cases die down. Here's why

For some former COVID-19 patients, elective surgeries may still be a risk even months after the initial infection, especially among those experiencing lingering virus symptoms, Kaiser Health News reported June 28. 

That's because a growing body of research indicates COVID-19 can affect multiple organs and systems. A number of studies have also shown the postoperative death rate among patients who've had COVID-19 is higher than those who've never been infected. 

One such study, published March 9 in Anaesthesia and cited by Kaiser, looked at the 30-day postoperative death rate of more than 140,000 patients across 116 countries who had elective or emergency surgery in October 2020. Among COVID-19 patients, the postoperative death rate was 4.1 percent for those who had surgery within two weeks of being diagnosed with COVID-19, findings showed. 

The longer patients waited to have surgery after their COVID-19 diagnosis, the more the postoperative mortality rate dropped, reaching 1.5 percent for those who had surgery at least seven weeks after diagnosis. Researchers observed the same postoperative death rate among those who were never infected. 

However, even at seven weeks, patients who had lingering symptoms still had a higher postoperative death risk compared to those who had asymptomatic COVID-19, or whose symptoms had fully resolved. 

While such research may help further inform guidance, some experts told KHN seven weeks is too arbitrary a threshold on which to base elective surgery scheduling. 

As a result, both patients and physicians are erring on the side of caution, choosing to delay procedures as long as possible in many cases. 

While the American Society of Anesthesiologists in December released guidelines for resuming surgery among former COVID-19 patients, they're not a one-size-fits all. Additionally, some hospitals have implemented their own pre-op exam protocol to clear patients who had the coronavirus for elective surgery. At some hospitals, that exam includes tests to evaluate cardiopulmonary function, coagulation status, and inflammatory markers and nutrition. 

"We know that COVID-19 has lingering effects even in people who had relatively mild disease," Don Goldmann, MD, professor at Harvard Medical School in Boston, told KHN. "We don't know why that is. But it's reasonable to assume, when we decide how long we should wait before performing elective surgery, that someone's respiratory or other systems may still be affected."


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