Updated guideline on surgical patient safety and COVID-19

17 May 2022

Read our updated guideline on surgical patient safety for SARS-CoV-2 (COVID-19) infection and vaccination.

We’re pleased to announce the second edition of our professional document PG68(A) Guideline on surgical patient safety for SARS-CoV-2 infection and vaccination.

This frequently updated "living guideline" document provides up-to-date advice to our fellows, trainees and specialist international medical graduates on navigating surgical patient safety concerns in the rapidly changing environment of the SARS-CoV-2 (COVID-19) pandemic.

This new edition has been produced via ongoing review of best available clinical evidence and relevant regulatory guidance. It takes account of helpful feedback from a number of our fellows, as well as colleagues from other parts of the health sector.

We’ve made a number of changes for this edition, including a minor title change. Important changes include:

  • Safe timing of non-urgent elective surgery after SARS-CoV-2 infection.

    Our general recommended delay of non-urgent elective major surgery after confirmed infection has changed to seven weeks.

    This assumes the patient has returned to baseline function and is symptom free. To assist decision-making, we’ve also added a provisional definition of major and minor surgery.
  • Time-sensitive surgery including cancer.

    Fellows have let us know that getting patients with cancer into urgent surgery without undue delay is an increasing source of concern.

    Our advice continues to be that the general recommendation does not apply to time-sensitive surgery such as cancer. Timing of these surgeries should be decided through shared decision-making, as informed by individualised risk assessment and clinical judgement, making note of the current evidence of perioperative outcomes for this patient group. We’ve made editorial changes to emphasise this advice.
  • Removed separate recommendation for vaccinated patients with ‘break-through’ SARS-CoV-2 infection.

    We’ve removed our separate recommendation for vaccinated patients with breakthrough infection because, upon review, the evidence was not strong enough to support it. We now recommend these patients should be treated the same as any other infected patient.
  • Determining whether patients are still infectious.

    We’ve noted new evidence that rapid antigen tests (RATs) may be useful inside 90 days of infection, and emphasised seeking infectious disease expert advice when in doubt.

    We’ve removed a distinction between omicron and other variants for determining when patients with mild/asymptomatic infection are no longer infectious.

    We’ve also added new advice on infectiousness of immunocompromised patients.

For the full list of changes to this edition, please see the change log at the end of the guideline.

As always, this guideline is a "living" document that will continue to be updated. Before making use of it, please check you have the latest version via the college website.

Thank you to the SARS-CoV-2 Surgery Guideline Working Group members Dr Vanessa Beavis, ANZCA President 2020-2022, Past ANZCA President Professor David A Scott, Perioperative Medicine Special Interest Group Chair Dr Jill Van Acker and Dr Joreline (Jay) Van Der Westhuizen for developing the document, and ANZCA’s representative on the National COVID-19 Clinical Evidence Taskforce, National Guidelines Leadership Group, Professor Paul Myles, who joined the working group for the second edition.

We invite suggestions and contributions for future versions, via email to sq@anzca.edu.au.

Last updated 14:17 17.05.2022