Changes to elective surgery rules in WA this week come as new research from the UK recommends that patients should avoid elective surgery for seven weeks after a COVID infection, unless the benefits of doing so exceed the risk of waiting.
Concerningly, the research also states that there is a three-fold risk of peri-operative mortality for asymptomatic patients for six weeks after a COVID infection with previous variants (such as Delta), and that asymptomatic or mild symptomatic infection with the Omicron variant also increases the risk.
There is no robust evidence demonstrating whether the risks of illness, infection and mortality after pre-operative or peri-operative infection with the Omicron variant are lower than with earlier variants, which poses a significant challenge for hospitals given Omicron’s current high rate of transmission within the community.
The multidisciplinary consensus statement issued on behalf of the Association of Anaesthetists, Centre for Perioperative Care, Federation of Surgical Specialty Associations, Royal College of Anaesthetists, and Royal College of Surgeons of England said patients should be individually assessed according to their risk profile if they need elective surgery within seven weeks of a COVID infection.
This assessment should include a baseline mortality risk calculation including patient specific factors (age and comorbidities), surgical factors (clinical priority, risk of disease progression and the complexity of surgery) and the severity of any COVID infection within the preceding seven weeks.
If elective surgery is still considered necessary within seven weeks of a diagnosis of COVID, the authors recommend that multidisciplinary discussions with the patient should take place to clearly communicate the risks and benefits, and they should be advised that a decision to proceed with surgery within the seven-week period will be pragmatic rather than evidence-based.
Patients with persistent symptoms and those with moderate-to-severe COVID may require a longer delay than seven weeks, and surgeons and anaesthetists should consider avoiding using general anaesthesia in favour of local or regional anaesthetic techniques.
Unsurprisingly, the research recommends that elective surgery should not take place within 10 days of diagnosis of a COVID infection because the patient may still be infectious, posing a risk to surgical pathways, staff and other patients.
The authors acknowledge that there is currently a lack of specific data to inform changes in perioperative risk and that the high number of patients with pre-operative Omicron infection, for people who have or have not been vaccinated, creates uncertainty and as further data emerges, the research recommendations may be revised.
An eight-week pause on non-urgent elective surgeries at public hospitals in WA remains in place until the 9th of May.