Trying to decide whether to have an operation
Trying to make your mind up about surgery can be difficult at the best of times. Now it is even more difficult as we have to factor in the additional risks that can arise because of COVID-19. Furthermore, the risks can be hard to quantify but we do know they vary between patients. You will want to know what those risks may be in your particular case.
COVID-19 related Issues that need to be considered
The situations that you need to consider are:
- Risk of getting COVID-19 as a result of going into hospital
- Risk of having an operation if you are already infected with COVID-19
- Potential for lack of backup resources from regular surgical and anaesthetic complications should they be needed whilst resources are under pressure from dealing with COVID-19 patients
- How to reduce the risks to yourself if you are having surgery
- Consider making an advance directive for your future care to cover various possible situations
Risk of getting COVID-19 as a result of going into hospital
Hospitals have worked hard to separate COVID and non-COVID patients and to keep their clinical front line staff from being unnecessarily exposed with the risk of those staff then passing the virus on to other patients. As a consequence hospital acquired infection rates appear to be low with one US study citing 0.45% rate. There may be more detailed information available from individual hospitals and policies for admission and to minimise risk along the patient journey are likely to have to vary from time to time and depending on what is happening in the wider community (preoperative testing for existing virus infection and self-isolation protocols, no visitors allowed).
Risk of having an operation if you are already infected with COVID-19 or get it in the immediate perioperative period
Earlier in the pandemic mortality rates for patients having significant procedures who had or became infected were around 15 – 24% at 30 days with absolute figures varying between studies. The cases included various types of general surgical procedures including a higher proportion of emergency cases. These figures showed higher risk for men, for patients over 70 years of age and for those with previous co-morbidities. As these figure are very high it is important to consider whether the surgery being considered needs to be done at this time or can be postponed. Where the operation can be done under a local or regional anaesthetic where you stay awake the risks are very considerably reduced. It is known that general anaesthetic results in the immune system being less effective for several days so during this time the immune system does not fight the virus so well should you be exposed to it.
Potential for lack of backup resources from regular surgical and anaesthetic complications should they be needed whilst resources are under pressure from dealing with COVID-19 patients
If you are having major surgery it is important that HDU/ITU facilities are available just in case of any unforeseen complications. This is a routine precaution in surgical practice. If such beds are occupied by COVID-19 patients then your planned operation cannot go ahead. Our private hospitals have not been treating COVID-19 cases and are designated COVID-19 light sites. This means the risk of transmission of a COVID-19 infection is low in these hospitals/units. Routine precautions are in place to reduce the chances of such infection. The normal principles governing safe surgery apply. Namely, the appropriate backups must be available for you.
How to reduce the risks to yourself if you are having surgery
As a patient you must be in the best possible state before your operation can proceed. #SAFE SURGERY To this end you will receive specific advices beforehand around being as fit as you can be. You also have your part to play in ensuring a good outcome from your procedure. You may be interested in prehabilitation which is how we work together to best prepare you for surgery so that you recover well afterwards.https://academic.oup.com/bjaed/article/17/12/401/4083340
Advance care planning directive
It is worthwhile to consider advance care planning before an operation so that you can discuss those needs with your surgeon beforehand. It is recommended that you discuss these with your family or next of kin so that they are aware of your wishes. Advance directives need to be expressed in writing, signed and witnessed. Templates are accessible for free download online and many companies can deal with your questions on this subject.
RCSEng COVID-19 Toolkit – Tool 5 Consent to treatment while COVID-19 still prevalent in society
Mitigating the risks of surgery during the COVID-19 pandemic. Comment. Lancet, May 29th 2020.
Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. COVIDSurg Collaborative, Lancet. 2020; (published online May 29.)
Rehabilitation. BJA Education, Volume 17, Issue 12, December 2017, Pages 401–405,