SH Task Force recommendations on peri-op COVID Testing

Protocol and guidelines start March 1

Since the COVID-19 pandemic began, the SARS-CoV-2 virus has mutated through variants of differing severity, people have gradually become vaccinated or previously infected and medical treatments of COVID have advanced.

Early studies involving prior variants revealed a dramatic worsening in peri-op morbidity and mortality related to COVID positivity that lasted roughly seven weeks beyond initial infection. Newer studies, perhaps more reflective of today’s ever-changing pandemic  milieu are mixed, yet it remains concerning that peri-operative COVID infection may still result in higher morbidity and mortality, the extent of which is unclear and still under active investigation particularly with asymptomatic patients who test positive.

While focusing on this probable heightened perioperative risk, and continuing to monitor emerging studies as SARS-CoV-2 evolves, the following protocol and guidelines were established and will be implemented starting Wednesday, March 1:

1. The CDC’s assessment of Marion county’s COVID-19 community level will be actively monitored by the task force and communicated to surgeons/physicians and their office staff.
2. When community level is LOW or MODERATE, ONLY SYMPTOMATIC PATIENTS will be COVID tested within 3 days of surgery/procedure (high risk patients/procedures as well as physicians’ discretion).
   1. Per CDC, possible symptoms of COVID-19 include: 
      1. Fever or chills
      2. Cough
      3. Shortness of breath or difficulty breathing
      4. Fatigue
      5. Muscle or body aches
      6. Headache
      7. New loss of taste or smell
      8. Sore throat
      9. Congestion or runny nose
      10. Nausea or vomiting
      11. Diarrhea
3. When the community level is HIGH, ALL PATIENTS will be COVID-tested within 3 days of surgery/procedure.

If a patient tests positive, surgery will be delayed at least seven weeks from the positive result, if medically safe to do so, per a discussion between the surgeon/physician and anesthesia. Medically urgent cases will proceed in the timeframe that is warranted, balancing the medical risks of surgical disease progression with probable COVID-related heightened morbidity/mortality. 

A patient’s positive home COVID test result and date will be used to direct medical care, whereas a patient’s negative home COVID test will be repeated per our institutional protocol. Test results/dates will be used for timelines and decision-making. 

Any provider can opt for personal airborne PPE regardless of patient’s test status. 

Newly positive patients will undergo appropriate quarantine/isolation and staff will wear the required PPE for at least 10 days after the test result.

Surgeons and physicians who perform surgeries/procedures in surgical services will be contacted directly in regards to assessment status and testing triggers.