Facing major surgery in the COVID-19 era
Many elective surgeries are being delayed due to COVID-19, but is it safer to wait or have surgery during a pandemic?By Mayo Clinic Staff
Coronavirus disease 2019 (COVID-19) has changed the way you go through your day — socializing, working, schooling, eating at a restaurant and filling the gas tank. Even a trip to the doctor's office is different due to COVID-19.
If you're facing a major surgery, you might wonder what preparation and recovery will look like. You might be anxious about whether you'll be safe during the procedure.
How COVID-19 affects surgery today
The COVID-19 pandemic has affected health care in many ways. This has often led to delays of nonurgent surgeries. If you're having a surgery that isn't urgently needed (elective surgery), your surgeon may recommend waiting until the pandemic ends.
Your surgeon might opt to delay an elective surgery to help:
- Protect your health
- Limit the spread of COVID-19 infection
- Save personal protective equipment (PPE) such as masks and gowns
- Save intensive care unit (ICU) hospital beds and other resources needed to care for hospitalized patients with COVID-19 infection
For example, surgery that involves general anesthesia requires a ventilator to help people breathe during the procedure. These ventilators may be needed for someone with severe COVID-19 infection.
But if having surgery now is what's best for your health, hospitals and their staff are taking careful steps to keep you safe.
How to decide the timing of your surgery
In some states, COVID-19 cases are declining or stable. Many hospitals are performing all types of surgeries again. Surgeons might look at these factors when determining whether or not to delay surgery:
- The urgency of your condition needing surgery
- Your overall health and any other medical conditions you may have
- Local COVID-19 activity
- Local stores of PPE supplies
- Length of inpatient recovery
- Whether or not recovery requires care in the ICU
Each surgery is looked at on an individual basis. Decisions may vary among hospitals and across the country.
Some elective or nonemergency surgeries may be postponed without a scheduled date, which may make you feel worried. Your surgeon will carefully consider the risks of waiting against having the surgery during the pandemic.
Your surgery will only be delayed if it won't put your health at risk or allow your condition to worsen. You and your surgeon will determine the safest approach for you: moving forward with surgery or delaying.
Studies have shown that delaying surgery for some types of earlier stage cancer for between three and six months didn't affect survival rates or rates of the cancer coming back. There may also be other types of therapy that can slow cancer growth while you wait for surgery.
If you need surgery to treat cancer, your surgeon will consider factors such as the stage of your cancer and how quickly it grows or spreads. Surgery may be urgently needed for people with some types of cancer.
Safety precautions at the hospital
Leading health institutions are providing guidance for hospitals to safely perform surgeries during the pandemic, as well as recommendations on when to delay.
Hospitals carefully screen patients before surgery to reduce the risk of spreading COVID-19. You'll be screened for common symptoms such as fever, cough and muscle aches and tested for the infection before your surgery. You may have more than one test.
You may need to self-quarantine for a period of time before your surgery to reduce your risk of exposure to the virus.
Hospital staff is also screened before each shift to check for fever or any signs of COVID-19 infection, such as coughing. Both staff and patients wear masks and practice social distancing.
Staff also wears PPE such as gowns, gloves and face masks when working with patients. Studies have shown that positive COVID-19 infection test rates in hospital staff decreased after universal masking was required.
Some research also shows that when health care workers wear PPE, their rates of infection are no higher than the general public. With these safety steps, the risk of a patient being infected with COVID-19 during surgery or in the hospital is extremely low.
In one study, a group of health care workers wearing appropriate PPE had no cases of COVID-19 infection, even working in direct contact with patients with COVID-19.
Hospitals are also taking more steps to thoroughly clean and sanitize all areas, including operating rooms.
Most hospitals also treat known patients infected with COVID-19 in separate areas of the hospital with staff who stay in that area. They travel different routes through the hospital to reduce the risk of spreading the virus. There may be separate entrances and waiting areas for patients with COVID-19. Visitors to the hospital are restricted or very limited.
Safety precautions you can take
You and your surgeon will discuss the steps you'll need to take before your surgery to protect yourself and others. Discuss these steps with your family members, and prepare them for what you'll need to do and what you'll need from them.
Explain that they may not be able to visit you in the hospital due to COVID-19 safety practices. Some hospitals may allow exceptions for women giving birth or children requiring surgery.
Before the surgery, take these steps:
- Avoid contact with anyone who has been diagnosed with COVID-19 or shows symptoms of COVID-19.
- Practice social distancing, avoid large gatherings, wear a mask and wash your hands frequently.
- Monitor yourself for symptoms and check your temperature.
- Ask questions about the hospital's precautions, visitor policies and how the surgery might impact your risk of getting COVID-19 infection.
Once you're out of the hospital and back home after your surgery, you'll still need to take steps to protect yourself and those around you.
Certain surgeries may make you more susceptible to infections. Ask your doctor if your recovery affects your risk of getting COVID-19 infection, and what preventive steps you can take.
After the surgery, take these steps:
- Continue to practice social distancing, avoid large gatherings, wear a mask and wash hands frequently.
- Discuss plans for your follow-up visits and care.
- Limit or restrict visitors in your home after your surgery.
- If you've been exposed to someone with COVID-19 infection, you may need to self-quarantine for 14 days and check your temperature daily.
Managing follow-up care
You and your doctor will discuss whether you need follow-up care in person at the doctor's office. Telehealth video or phone calls or visits from in-home health care professionals may be options for you.
If you need to go to the doctor's office:
- Wear a mask
- Wash your hands often
- Practice social distancing
Talk to your doctor if you have concerns about in-home health care. Just as in-hospital staff does, these caregivers take precautions to prevent spreading COVID-19 by wearing PPE. They are also screened and tested regularly. Ask your caregiver about the specific steps taken to protect against COVID-19.
Aug. 22, 2020
See more In-depth
- Post-COVID-19 readiness checklist for resuming surgery. American College of Surgeons. https://www.facs.org/covid-19/checklist. Accessed July 22, 2020.
- Preparing to have surgery during the time of COVID-19. American College of Surgeons. https://www.facs.org/-/media/files/covid19/covid19_surgeon_patient_discussion_guide.ashx. Accessed July 22, 2020.
- COVID-19 and surgical procedures: A guide for patients. American College of Surgeons. https://www.facs.org/covid-19/clinical-guidance/patient-guide. Accessed July 22, 2020.
- UPDATE: ASA and APSF joint statement on perioperative testing for the COVID-19 virus. Anesthesia Patient Safety Foundation. https://www.apsf.org/news-updates/asa-and-apsf-joint-statement-on-perioperative-testing-for-the-covid-19-virus/. Accessed June 22, 2020.
- Questions and answers for patients regarding elective surgery and COVID-19. American Academy of Orthopaedic Surgeons. https://www.orthoinfo.org/en/treatment/questions-and-answers-for-patients-regarding-elective-surgery-and-covid-19/. Accessed June 22, 2020.
- Fader AN, et al. When to operate, hesitate and reintegrate: Society of Gynecologic Oncology surgical considerations during the COVID-19 pandemic. Gynecologic Oncology. 2020; doi.org/10.1016/j.ygyno.2020.06.001.
- Wallis CJD, et al. Risks from deferring treatment for genitourinary cancers: A collaborative review to aid triage and management during the COVID-19 pandemic. European Association of Urology. 2020; doi.org/10.1016/j.eururo.2020.04.063.
- Palmore TN. Coronavirus disease 2019 (COVID-19): Infection control in health care and home settings. https://www.uptodate.com/contents/search. Accessed July 28, 2020.
- Marshall WF (expert opinion). Mayo Clinic. Aug. 1, 2020.