Preoperative testing for COVID-19 important, regardless of vaccination: ASA and APSF Statement
USA: The American Society of Anesthesiologists and Anesthesia Patient Safety Foundation has released updated guidance on perioperative testing for the COVID-19 virus.
According to the statement, all patients undergoing non-emergency surgeries or procedures should continue to have preoperative polymerase chain reaction (PCR) testing for SARS-CoV-2, irrespective of vaccination status.
There is a need for a robust perioperative screening and testing program to detect SARS-CoV-2 for the safety of patients, health care workers, and the general public owing to the prevalence of the Delta variant driving an increase in COVID-19 cases in the U.S., and the recent findings by the Centers for Disease Control and Prevention (CDC) regarding breakthrough infections in fully vaccinated individuals, the statement notes.
"Considering the ongoing and evolving pandemic, all patients undergoing an anesthetic, procedure, or surgery with the potential to generate aerosols should continue to have preoperative testing for SARS-CoV-2, ideally within three days prior to the procedure," said ASA President Beverly K. Philip, M.D., FACA, FASA. "This is a critical safety measure, considering that fully vaccinated individuals, symptomatic or asymptomatic, have the potential to transmit the virus. The updated joint guidance on testing and screening will help surgeons and proceduralists, working together with physician anesthesiologists, to better evaluate and schedule patients."
Recently, ASA and APSF surveyed a group of leading medical centers and others to learn how their testing protocols might have evolved through July 2021, with specific attention to their approach to preoperative testing for patients who have been fully vaccinated for COVID-19. In almost all cases, these institutions continue to require COVID preoperative testing for all patients, including those who have been fully vaccinated.
Additionally, the statement recommends that when there is a risk of local or regional community transmission of SARS-CoV-2, all patients, including those who have been fully vaccinated, should be screened for symptoms prior to presenting to the health care facility. Patients reporting symptoms should be referred for additional evaluation. All other patients should undergo nucleic acid amplification testing (e.g., PCR tests) prior to undergoing non-emergent surgery. If a patient tests positive for SARS-CoV-2, elective surgical procedures should be delayed until the patient is no longer infectious and has demonstrated recovery from COVID-19.
Read the complete, updated statement "ASA and APSF Statement on Perioperative Testing for the COVID-19 Virus," here.
Access all of ASA's statements, resources, and recommendations on COVID-19 here.
Recommendations:
A population risk assessment identifying the prevalence of SARS-CoV-2 should be reviewed. When there is local or regional community transmission(16,17)of SARS-CoV-2:
1) All patients should be screened for symptoms prior to presenting to the health care facility. Patients reporting symptoms should be referred for additional evaluation. All other patients should undergo nucleic acid amplification testing (e.g., PCR tests) prior to undergoing non-emergent surgery.
2) If a patient tests positive for SARS-CoV-2, elective surgical procedures should be delayed until the patient is no longer infectious and has demonstrated recovery from COVID-19. A patient may be infectious until either:
CDC non-test-based strategy in mild-moderate cases of COVID-19:
· At least 24 hours since resolution of fever without the use of fever- reducing medications and improvement in respiratory symptoms, and
· At least 10 days since symptoms first appeared.
CDC non-test-based strategy in severe cases of COVID-19 or in immunocompromised patients:
· At least 10 days and up to 20 days have passed since symptom onset,
· At least 24 hours since resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms, and
· Symptoms (e.g., cough, shortness of breath) have improved.
3) Considering the ongoing and evolving pandemic, all patients undergoing an anesthetic, procedure, or surgery with the potential to generate aerosols should continue to have preoperative PCR testing for SARS-CoV-2, ideally ≤ three days prior to the procedure, irrespective of vaccination status.
Reference:
ASA and APSF Statement on Perioperative Testing for the COVID-19 Virus
