Scheduling Surgery

  1. Scheduling Considerations
    • a. A pre-symptomatic COVID-19 positive surgical patient could face recovery challenges due to experiencing COVID-19 symptoms and quarantine.
    • b. It is possible, though the data is unclear at the time of this publication, the surgery itself might worsen a patient’s postoperative clinical course of COVID-19, or increase their risk for complications, hospitalization or death.
    • c. A COVID-19 infected patient could expose health care workers, including you!
    • d. Lower risk surgical procedures should be considered when first re-starting.
    • e. Patient risk factors: consider these patient risk factors thought to exacerbate a COVID-19 infection:
      • i. Increasing Age (esp. age>65)
      • ii. Male sex
      • iii. Obesity (BMI>35)
      • iv. Diabetes Mellitus
      • v. Autoimmune Disease
      • vi. Blood transfusion
      • vii. Cardiovascular Disease (Hypertension, Coronary Artery Disease, CHF)
      • viii. Hypercoagulable conditions
      • ix. Immunosuppressive medications (steroid use / DMARDS & biologics** / transplant medications)
      • x. Kidney Disease (Glomerulonephritis / Renal Impairment, etc.)
      • xi. Length of surgery
      • xii. Lung Diseases (e.g. COPD, interstitial lung diseases, pulmonary fibrosis, pulmonary hypertension)
      • xiii. Obstructive Sleep Apnea
      • xiv. Smoking and vaping

    **DMARD = disease modifying anti-rheumatic drugs, such as azathioprine, methotrexate, leflunomide
    **Biologics = Humira, Enbrel, Remicade and others.

  2. Surgical factors of note:
    • a. Site: Nose & septum / sinus / intra-oral surgery
    • b. Surgical effect on post-op pulmonary function (e.g. abdominoplasty)
    • c. Consider scrub tech’s & surgeon’s own co-morbidities from the above list.
  3. Preoperative Work-up
    • a. No changes need be made to routine lab testing, medical consults and clearance policy as indicated for age and medical history. If the patient has recovered from previous documented COVID-19 infection, consult your local infectious disease expert.
    • b. WHERE AVAILABLE pre-operative COVID-19 testing (see Testing for COVID-19).
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