Covid keeps evolving. The original Covid was terrible for surgery- lung involvement, clotting issues, oxygen desaturation. At this point after 3 years, almost no one can still likely be Covid free. All of the people I knew who were avoiding it have been getting it recently.
So what does this mean for surgery? This is an article from March 2022 Aesthetic Surgery Journal. “Evaluation of the Post COVID Patient Prior to Elective Plastic Surgery: Developoing an Evidence-Based Framework.”
I almost hesitate to write about this, as the Editorial decision date of this article is September 2021. It was probably written even earlier than that. We doctors can tell that the original Covid strain is different than the delta strain which is different than the omicron strain. So we need to take this with a grain of salt.
So what does the article say?
They looked at regular non surgery people after Covid. They found at 4-6 weeks after discharge, 40% of the inpatients still had identifiable issues with their heart and lungs. ICU patients were 2.8 times more likely than those on inpatient wards. By 2-3 months out, 1/3 of those with moderate or severe Covid still had abnormal chest X-rays and lung function.
*MY OWN EDITORIAL NOTE: These are patients with Covid severe enough to be hospitalized, and these patients were likely 2020-2021. Different Covid strain. And they do not discuss if they were vaccinated/boosted/had other medical issues/etc.
There was a study out of England early on where in patients who had active Covid and elective surgery, the 30 day MORTALITY for elective surgery was 19%, and that went up to 26% for elective surgery. (!!!) At 7 weeks out, the risk of mortality decreased to that of normal controls. The authors go on to state that they think the 7 week number is suitable for patients who had mild cases and have had complete resolution of symptoms and full return to normal, and not for inpatients/sick people.
They then allude the anesthesia society recommendations, which I wrote about previously. Read my thoughts on whether you should wait to have elective surgery after having COVID.
So what do they think now?
- The severity of the prior Covid infection makes a significant difference
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- MILD = outpatient
- MEDIUM requires hospital admission and/or oxygen, but no ICU
- SEVERE requires ICU or ventilator
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- Basic tests to consider if a patient who wants surgery was in the hospital: EKG, Chest X ray, coagulation panel/D dimer, inflammatory markers like CRP, ESR, consider a cardiology/pulmonology consult
- A simple 6 minute walk test is a good screen- check pre and post oxygen levels to screen for exercise tolerance and function.
- Getting a vaccine 2 or more weeks prior to surgery is good. It lowers the chance of you getting a new infection in the perioperative time.
My thoughts?
As I mentioned above, Covid is evolving. The current strain is not nearly as virulent as the first, and with people being vaccinated, boosted, or having covid already, there are varying degrees of immunity. The current strain doesn’t seem to have quite the same lung and blood clotting effects. So this study, as quickly as it was published, is likely outdated. But basic tenets still hold true, particularly when doing elective surgery.
I like the anesthesia guidelines, which make you wait 4-8 weeks after you have Covid before surgery depending on how symptomatic you were.
I like the idea of you feeling normal (exercise tolerance, not short of breath or coughing or whatnot) prior to surgery.
Our recommendations and understanding are going to continue to change. All of this is still evolving. What we advocate today may change as we understand more and as Covid keeps changing. Every strain is different. Every person reacts a bit differently. Surgeries are different- I feel differently about an eyelid surgery than I do about a tummy tuck and the risk of clotting or other things.
There is risk with all surgery. We try to be smart and reduce that risk as much as we can.