Questions and Answers for Patients Regarding Elective Surgery and COVID-19

*Originally posted at Orthoinfo.

In many cities and states, nonessential orthopaedic surgeries that were postponed due to the COVID-19 pandemic are now resuming. This resource was created to help address questions and concerns patients may have about the impact of COVID-19 on their rescheduled procedures. If you are scheduled for orthopaedic surgery, your doctor will talk with you about the specific protocols followed by your hospital or surgical facility.

Is it safe to have my surgery?

As orthopaedic surgeons, your safety as a patient is our primary concern.

Now that the number of acute COVID-19 cases has begun to decline and there is “flattening of the curve” in many places, many facilities have started to resume elective orthopaedic procedures.

Surgical facilities will follow federal, state, and local guidelines in making the decision to reopen for elective surgery.

During the course of the COVID-19 pandemic, orthopaedic surgeons have continued to provide critical emergency surgical care to patients safely and effectively.  Our experience with these patients allows the doctors and facilities to make your scheduled surgery as safe and successful as possible. Ensuring your safety as a patient is our primary concern.

Your surgeon can explain to you what precautions are in place at the facility where you will be having surgery and what procedures you and your family will need to follow to make your surgery as safe and successful as possible.

What precautions are taken to make sure the facility is safe?

Your hospital or outpatient surgical facility will follow extensive sterilization and sanitization procedures in line with both government and industry recommendations. Our facilities have a high air flow and sanitization rate in the operating rooms, which helps to decrease potential disease transmission. In many cases, this may mean that the time between surgical procedures will be longer than normal and that fewer surgeries can be scheduled in an operating room during a single day.

Operating room and other facility personnel will typically be screened routinely, with the frequency depending on local conditions. Personnel will likely be tested for the virus if there is any question of illness.

The facility may also place limitations on whether visitors may come into the facility or may provide a designated waiting area away from the operating suite. Social distancing will be practiced in waiting areas.

If I am having surgery, will I require screening and/or testing?

Screening and/or testing of all patients having surgery will be required to make sure you have had no known exposure to COVID-19 and you have had no symptoms consistent with the disease.  No test or screening in 100% accurate, so you may be screened or tested more than once to help safeguard you during your surgery.

Your surgical facility, whether it is a hospital or surgery center, will have a protocol for both screening and testing.

What is the difference between screening and testing?

Screening means you are evaluated for symptoms and findings of COVID-19 disease. This takes the form of questions to make sure that you have no history of symptoms to indicate you are actively sick. You will be asked if you have had recent close contact with anyone known to have the disease. A physical examination, including a temperature check, will also be part of the screening process.

Testing means that you have a physical test to make sure that you are not sick with the virus. A sample is taken from your nasal passages or your saliva and sent to a laboratory to be tested.

When will screening and/or testing take place?

You will need to be evaluated several days before your surgery and again when you arrive at the surgical facility. This is to make sure that no changes have taken place since your first evaluation.

Some hospitals or surgery centers may require that you self-isolate or quarantine between the time of your preoperative evaluation and the day of your surgery.

What happens if there is a problem with my preoperative evaluation?

If there is anything in your preoperative evaluation that suggests there might be a problem, your surgery will be postponed. This is for your own safety, as you would not want to have surgery if there were some chance that you might have COVID-19.

If you have mild symptoms, such as a sore throat or cough, these will need to be checked even if your virus test is negative. That way you will know it is safe to go forward with surgery.

Obviously, if there is a true emergency, then surgery will have to proceed even though the risks are greater.

If my surgery is postponed, how long do I have to wait to be rescheduled?

Your surgery can be rescheduled once you are symptom-free and your virus test is negative. If you have had COVID-19, you will need to be rechecked by your primary care physician to make sure you are medically cleared for surgery.  Ensuring your safety is always our primary concern. Once you are medically cleared for surgery, your orthopaedic surgeon can help get you “back on the schedule” in a timely fashion.

If I am having surgery at a hospital, will I be in an area close to where patients have COVID-19?

Most hospital facilities will keep COVID-19 patients in separate areas that are being taken care of by a different group of hospital workers and nurses.

Can I bring a family member?  Can they wait with me before and after my surgery?

The rules for friends and family are different for each surgical procedure facility. Almost all procedures will require at least some degree of sedation even if you are not having general anesthesia. That means that someone will need to take you to the facility and someone will need to drive you home. A friend or family member will also need to receive your discharge instructions.

Depending upon the facility, your friend or family member may be able to wait in a specially designated area or may only be able to drop you off and pick you up at the entrance to the facility. Some exceptions may be made if you are a parent bringing a pediatric patient for surgery.

Should I quarantine before my surgery?

Many facilities will recommend that you quarantine for several days before surgery. Typically, this is done between the time you were screened and/or tested and the time of your scheduled surgery. Your surgeon will advise you as to what needs to be done and what precautions you should take before your procedure. The recommendations will partly be based on the protocols followed by the facility where you are having surgery.

What can I do at home before and after surgery to decrease my risk of contracting the virus?

It is important to take precautions against the spread of COVID-19 disease both before and after surgery. Avoid crowds, maintain social distancing, practice good hygiene, and try to avoid close contact with friends or family members who work in areas where they may be exposed to the virus.

What is the difference between viral and antibody testing?

A viral (antigen) test can be done to determine if you have active COVID-19 disease. This is done by inserting a long swab into your nasal passages or by obtaining a saliva specimen. If it is positive, you may need to seek further treatment and avoid contact with others to prevent the spread of the disease. Most viral tests are about 80-90% accurate.

An antibody test is done by drawing a blood specimen.  It should be able to tell if you have had COVID-19 disease, but the accuracy of the currently available antibody tests is uncertain.  If you have a negative test, it could be what is called a “false negative,” meaning that you have been exposed to the virus, but the test was inaccurate. On the other hand, if you have a positive test, it means that you have been exposed to the virus, but it does not mean you have immunity against getting the disease again. There is currently a great deal of research going on in this area and we hope to have an accurate antibody test very soon.

What happens to me if I develop symptoms of COVID- 19 after my surgery?

Even though you may have tested negative for COVID-19 before surgery, it is certainly possible to contract the virus afterward. If you are experiencing symptoms such as fever, headache, nausea, vomiting or shortness of breath, contact your physician and you will be given appropriate treatment.

This patient resource was developed by the American Academy of Orthopaedic Surgeons with input and endorsement from the orthopaedic subspecialty societies listed below.

American Association for Hand Surgery
American Association of Hip and Knee Surgeons
American Orthopaedic Foot and Ankle Society
American Orthopaedic Society for Sports Medicine
American Shoulder and Elbow Surgeons
American Society for Surgery of the Hand
American Spinal Injury Association
Arthroscopy Association of North America
Cervical Spine Research Society
J. Robert Gladden Orthopaedic Society
Limb Lengthening and Reconstruction Society
Musculoskeletal Infection Society
Musculoskeletal Tumor Society
North American Spine Society
Orthopaedic Research Society
Orthopaedic Trauma Association
Pediatric Orthopaedic Society of North America
Ruth Jackson Orthopaedic Society
Scoliosis Research Society
Society of Military Orthopaedic Surgeons
The Hip Society

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