Unvaccinated Patients Should Wait 7 Weeks for Nonemergency Surgery After COVID-19

According to a new joint statement published by the American Society of Anesthesiologists (ASA) and the Anesthesia Patient Safety Foundation (APSF), unvaccinated patients should have elective (nonemergency, planned) surgery delayed for at least 7 weeks after COVID-19 infection.

For people who develop COVID-19 despite being fully vaccinated against COVID-19, there is no consensus on how to determine the interval between infection and elective surgery. Dr. Randall M. Clark, president of the American Society of Anesthesiologists (ASA), said doctors should use clinical judgment when scheduling surgery. All doctors, anesthesiologists, surgeons and others need to base decisions to proceed with elective surgery on patients' symptoms, their need for surgery and whether delays could cause other health problems.

How Long Should Surgery Be Delayed After COVID-19?

Before these updated recommendations were published on February 22, 2022, ASA and APSF had recommended a 4-week gap between COVID-19 diagnosis and elective surgery for asymptomatic or mild cases, regardless of vaccination status.

The waiting period was extended from 4 to 7 weeks based on follow-up of more than 140,000 surgical patients in October 2020 in a multinational study. Patients with a previous COVID-19 infection had an increased risk of complications and death during elective surgery for up to 6 weeks after diagnosis compared with those without COVID-19. Additional US research found that patients diagnosed with COVID before surgery were at higher risk of postoperative respiratory failure for up to 4 weeks after diagnosis and postoperative pneumonia for up to 8 weeks.

Because these studies were conducted in unvaccinated populations or those with low vaccination rates, and preliminary data suggest vaccinated patients may have lower risks of complications and death after infection, "We thought it prudent to make specific recommendations only for unvaccinated patients." Clark added.

Although this guideline is “very helpful” in summarizing available research to make evidence-based recommendations, a 7-week waiting period appears to be “a very conservative estimate.” Many healthcare centers currently schedule surgery after at least 3 weeks, regardless of vaccination status.

It should be remembered that this study was conducted before the widespread emergence of the Omicron variant, which causes less severe disease. Omicron is currently the most common COVID-19 variant and is less lethal than previous variants of the virus. Therefore, people who develop COVID-19 due to Omicron may not necessarily need to wait 7 weeks.

In conclusion, the recommendation to wait at least 4 weeks from COVID-19 diagnosis before elective surgery still stands, regardless of vaccination status. However, waiting 7 weeks is particularly important for people with comorbidities, those who developed COVID-19 while unvaccinated and those who had severe COVID-19 despite vaccination.