Abstract
To the Editor:
S The study found that the risk of elective surgery and the incidence of post-operative complications within six weeks after COVID-19 infection increased by several times.
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Therefore, the peri-operative risk of all patients infected with COVID-19 (within six weeks) needs to weigh the advantages and disadvantages (the benefits of surgery and the risks of surgical anesthesia). The pre-operative evaluation of patients with COVID-19 infection includes: symptoms, severity, duration of COVID-19 infection, and symptoms after COVID-19 infection.
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Thoracic computed tomography, electrocardiograms, cardiac ultrasound, myocardial zymogram, blood gas analysis, blood cell analysis, β-type natriuretic peptide, liver and kidney function, electrolyte, coagulation function, and other tests should be completed before operation. For patients who meet the criteria for elective surgery, if there is no abnormality in the above tests, local anesthesia and regional block (spinal anesthesia or nerve block) can be administered. For operations under general anesthesia (tracheal intubation, laryngeal mask airway general anesthesia), the above assessment can be started at least two weeks after recovery from COVID-19. For patients over 70 years old,
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with diabetes mellitus, poor blood glucose control (fasting blood glucose >10 mmol/L), low immune function, chronic obstructive pulmonary disease (COPD), and heart disease, the elective surgery should be suspended within four weeks after the recovery from COVID-19 infection, and those without symptoms after four weeks should be re-evaluated according to the above pre-operative evaluation. Major operations such as lung surgery, abdominal surgery, craniocerebral surgery and other complex operations should be comprehensively evaluated four weeks after the recovery from COVID-19 infection. If there is no surgical contraindication, elective surgery can be performed. The patients recovered from COVID-19 infection (without residual respiratory or other system symptoms, except the patients with high-risk factors and major surgery mentioned in points 4 and 5) can undergo surgery at a selected time, and the patients with residual respiratory symptoms, tachycardia (more than 120 times per minute), and general fatigue should be suspended from the operation at a selected time. Emergency surgery is not limited by the above requirements. The operation within a time limit should be carried out after weighing the benefits and risks of the operation, fully informing the patients and their families, and obtaining written informed consent. In principle, children (under 12 years old) should undergo elective surgery four weeks after their recovery from COVID-19 infection. For children who have recovered from COVID-19 infection for more than two weeks, the elective surgery can be performed after fully informing the family members of the children of the relevant risks without respiratory symptoms, blood routine, and chest imaging abnormalities. To evaluate the patients who need to go to the intensive care unit for resuscitation and monitoring observation after surgery, the doctor in charge should inform the family members of the condition in advance. The timing and risk assessment of elective surgery after COVID-19 infection should also adhere to the principle of individualization, conduct multidisciplinary consultation for specific patients, conduct a comprehensive assessment of patients, and develop a complete operation and anesthesia plan.
At present, we evaluate the operation opportunity in accordance with the above simple guidance on the timing and risk assessment of COVID-19–infected patients to minimize the impact of COVID-19 infection on patients while meeting the normal medical needs of the people. With the constant variation of COVID-19, the above simple guidance needs to be constantly adjusted and improved in clinical practice.