The following are key points to remember from this updated consensus statement on timing of elective surgery and risk assessment after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection:

1. In a prospective cohort study conducted in October 2020 (COVIDSurg Collaborative and GlobalSurg Collaborative, Anaesthesia 2021;76:748-58), patients undergoing surgery following SARS-CoV-2 infection had increased mortality for up to 6 weeks following infection. Therefore, the groups involved in the present consensus statement had released a previous version of the statement in March 2021, recommending that elective surgery be deferred for ≥7 weeks following SARS-CoV-2 infection, unless risks of deferring surgery outweighed the benefits.
2. There are no published data on perioperative risk following infection with the Omicron variant. The authors caution against assuming that perioperative risks with mildly symptomatic Omicron infection would be lower than that with Delta infection. They have not changed the recommendation to defer elective surgery for ≥7 weeks following infection, even in asymptomatic patients, unless risks of deferring outweigh benefits. The American Society of Anesthesiologists maintains a slightly different viewpoint, recommending that elective surgery be deferred for 7 weeks in unvaccinated patients who are asymptomatic at the time of surgery, but acknowledging that for vaccinated individuals, the appropriate length of time between coronavirus disease 2019 (COVID) diagnosis and surgery remains unclear (https://www.apsf.org).
3. Elective surgery should not take place for ≥10 days following SARS-CoV-2 infection, as the patient may be infectious and place staff and other patients at undue risk. Preoperative vaccination, ideally with three doses of mRNA-based vaccine, is highly recommended, as it is the most effective means of reducing infection severity.
4. Patients with symptoms persisting beyond the 7-week mark, and those hospitalized for COVID-19, are likely at greater risk of perioperative mortality. Therefore, deferring surgery for a longer period of time should be considered.
5. Baseline perioperative risk should be assessed with a validated tool. Choices include the United Kingdom-based SORT-2 (sortsurgery.com) and the American College of Surgeon’s NSQIP surgical risk calculator (riskcalculator.facs.org). In the post-COVID setting, surgical risk may be particularly increased in patients aged >70 years, those undergoing major surgery (e.g., cardiothoracic, hepatobiliary, vascular, and complex orthopedic procedures), and those with ongoing COVID symptoms or prior hospitalization for COVID.
6. Clinicians and patients should engage in shared decision making regarding surgical timing, informed by the patient’s baseline risk factors, severity and timing of SARS-CoV-2 infection, and surgical factors (clinical priority, risk of disease progression, and complexity of surgery).

Clinical Topics: Arrhythmias and Clinical EP, COVID-19 Hub, Geriatric Cardiology, Prevention

Keywords: Anesthesia, Anesthesiologists, Antibodies, Viral, COVID-19, Geriatrics, Hepatitis D, Orthopedic Procedures, Postoperative Complications, Primary Prevention, Risk Assessment, Risk Factors, RNA, Messenger, SARS-CoV-2, Elective Surgical Procedures, Thoracic Surgery, Vaccination, Vascular Diseases, Viral Vaccines

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