COVID-19 and Elective Surgery

1. What is the definition of elective cases?

• While the Anesthesia Quality Institute definition of elective surgery is “a surgical, therapeutic or diagnostic procedure that can be performed at any time or date between the surgeon and patient,” this definition doesn’t reflect nuances that exist in scheduling operative procedures at the current time.
• When working with surgeons on scheduling cases, consider reviewing the American College of Surgeons (ACS) statement that includes an Elective Surgery Acuity Scale (ESAS) that balances a patient’s need or impact of a surgical procedure with available resources. Many cancer cases are considered time-sensitive. We recommend close collaboration between surgeons, anesthesiologists, and hospital administration to balance individual patient needs with system resource constraints.

2. What precautions should be placed on an elective surgery patient who was exposed to COVID-19 via a positive family member and/or cohabitant?

• The ASA and APSF Statement on Perioperative Testing for the COVID-19 Virus includes recommendations for both testing and screening of surgical patients.

3. How long should a patient wait to have elective surgery after they have had a confirmed COVID-19 infection?

• If a patient tests positive for SARS-CoV-2, elective surgical procedures should be delayed until the patient is no longer infectious and has demonstrated recovery from COVID-19. The timing of elective surgery after recovery from COVID-19 uses both symptom- and severity-based categories. Please refer to the ASA-APSF Joint Statement on Elective Surgery and Anesthesia for Patients after COVID-19 Infection for further information.
  
  
  • A patient may be infectious until either, based upon a CDC non-test-based strategy in mild-moderate cases of COVID-19: a) At least 24 hours since resolution of fever without the use of fever- reducing medications and improvement in respiratory symptoms, and b) at least 10 days since symptoms first appeared OR via a CDC non-test-based strategy in severe cases of COVID-19 or in immunocompromised patients: a) At least 10 days and up to 20 days have passed since symptom onset and b) At least 24 hours since resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms, and c) Symptoms (e.g., cough, shortness of breath) have improved.  

• General
• Anesthesia Machines and Equipment Maintenance
• Clinical Care
• Federal Advocacy
• Hospital and Facility Administration
• Occupational Safety and Wellness
• Personal Protective Equipment
• Practice Management and Billing
• Patient Testing

Disclaimer

Viewers of this material should review these FAQs with appropriate medical and legal counsel and make their own determinations as to relevance to their particular practice setting and compliance with state and federal laws and regulations. The ASA has used its best efforts to provide accurate information. However, this material is provided only for informational purposes and does not constitute medical or legal advice. This response also should not be construed as representing ASA policy (unless otherwise stated), making clinical recommendations, dictating payment policy, or substituting for the judgment of a physician and consultation with independent legal counsel.