Increased risk of death under general anaesthesia following Covid

[DanielTigersMummy21]

Toddler DD has to have an operation and I was shocked to be told that if she tests positive for Covid she cannot have GA for 7 weeks afterwards. Has anyone else heard of this?

The reason given was that a recent Covid infection significantly increase the risks of death under GA, because of vascular changes. I have been very pro back to normal but this has somewhat shaken me. I feel like other parents should be aware of this risk as we are generally told that Covid is not a risk to children.

I have no idea what to do with DD whilst we wait on confirmation of her operation date. She is currently in nursery whilst we both WFH but am considering pulling her out and asking work for unpaid leave. We have already experienced long delays for her operation, she is sometimes in pain and I feel like as a family we just couldn't cope with another delay due to a positive test.

There's been a lot about postponing elective surgery following a Covid infection. That's why people have been advised to wait.

Absolutely not unreasonable to bring her out and to have a degree of isolation to reduce the risk of an infection before the operation.

On the basis of the increased risk to her of being under general anaesthetic following a case of Covid, it’s not necessarily a particular point with Covid but that various conditions could be a factor affecting someone under anaesthetic, and unless the operation is time sensitive then it’s a risk that does not need to be taken

I had heard about postponing elective surgeries. I think I completely misunderstood what an elective surgery is. Having just googled it, elective surgery is anything that is pre scheduled and not a medical emergency? So most surgery is elective, even if postponing the surgery will eventually result in a medical emergency?

Yes, that's right OP. That's why discussion around 'elective' C-sections can be so inflammatory: it just means you know in advance - say you've found out baby is breech- rather than you're midway through labour, something goes wrong and you're whisked in for an emergency section. Same applies to all surgeries, its everything that's scheduled.

Thank you for sharing: toddler DD had covid a couple of months ago and I have been feeling somewhat relieved now she's through it as we'll both be fully vaccinated soon and she'll have some immunity so it feels a bit 'safer'. I hadn't heard of risks re: general anaesthetic.

As someone who has an 11 year old with long covid, please do not underestimate the risk of covid to the children. My sons doctor told me they are seeing an awful lot of LC symptoms in children who have had the virus. In fact, long covid in children is more common that they initially expected it to be. My son got over the initial infection really well but has suffered immensely this past 8 months. We are still only learning the effects of covid.

I had emergency surgery under general anaesthetic right after having covid and this wasn’t explained to me at all..

and yet here is the Gov policy, not a thought for the vulnerable. This is making me very angry

Government believes cases are set to start falling next month – reports
Ministers believe COVID cases are set to peak mid-August and start falling, the Evening Standard reports.
According to the newspaper, the hope is that data out soon confirms this.
The government reportedly believes COVID will "run out" of people to infect after ripping through unvaccinated and single-jabbed people.
It has reportedly been dubbed "hybrid immunity" by Department of Health officials.
This is said to describe the protection from jabbing older and more vulnerable people, combined with a mix of natural immunity and vaccinations in younger people.

@Sacredspace that’s scary but glad you are ok. I think there isn’t much that’s known so that is why it wouldn’t have been explained

I imagine that for emergency surgery the need outweighs the risk.
All surgery carries a certain risk so eliminating one from covid changes to the vascular system makes sense.
That is partly the reason for pre-op isolation.

Interesting, DD2 had surgery last week and nobody asked whether she’d had COVID... luckily all fine.

What if you have had it asymptomatic? Obviously you wouldn't know you have had it, so is it still a risk to have a GA?

Thanks for your responses. Still feeling worried about this. Have done a bit of hunting online and found the research supporting this if anyone is interested.

Here is a link to a statement published by several professional medical bodies, incurred Royal College of Anaesthetists: associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15464

Including, not incurred

The report advises 'Elective surgery should not be scheduled within 7 weeks of a diagnosis of SARS-CoV-2 infection unless the risks of deferring surgery outweigh the risk of postoperative morbidity or mortality associated with COVID-19'

I'm not going to quote huge sections, but that 7 week wait is advised for transient and asymptomatic cases. Later in the report there is a bit that advises that those with moderate or severe symptoms will need a longer delay before surgery.

There is a bit about how much more likely patients are to die following and operation in the weeks after Covid, but I don't understand what they mean by odds ratio. Please can someone with a better understanding of maths/ statistics explain this bit:

'Compared with patients who did not have previous SARS-CoV-2 infection, the odds ratio (95%CI) of 30-day mortality when operating at 0–2 weeks, 3–4 weeks, 5–6 weeks were 3.22 (2.55–4.07), 3.03 (2.03-4.52) and 2.78 (1.64–4.71), respectively.'

An odds ratio is basically how many times more likely something is to happen. So say for example that an operation normally has a 1% mortality rate - an odds ratio of 3.22 means that the mortality (at 30 days in this case) goes up to 3.22%

Thankfully most operations are far less risky and so a high odds ratio will still have a low mortality rate. For example an operation with a usual mortality rate of 0.01% will go up to 0.03% - significant enough to be worth delaying but still very low.

This isn’t really anything new. Elective surgery has been postponed after respiratory infections for a long time, but there are some quirks of covid that make it a bit more challenging than your average resp infection.

The main risks relate to airway irritability during a GA, and the pro-inflammatory state that surgery induces in combination with the risk of blood clots with covid. There are other issues for those who’ve had severe illness, including the immunosuppression that some of the treatments for severe disease cause, and the de conditioning that comes with severe illness.

The rules aren’t written in stone because every patient is different and there’s a whole bunch of things that have to be factored in, including what the operation is, how urgent it is, how fit they were before they got covid, how unwell they were with covid, etc. In addition, the consequences of presenting as an emergency if the elective procedure is deferred have to be considered. So the risk for someone with bowel cancer may justify their surgery happening sooner than 7 weeks whereas those for someone waiting for grommets doesn’t. Or a frail person with multiple illnesses may be advised to wait longer than someone who’s usually fit and healthy even though they’re having the same surgery.

Where the benefits of surgery outweigh the risk of covid related complications, techniques may be adapted (both anaesthetic and surgical) to try and reduce the chance of complications and thought will be given to post op monitoring/ management of any complications.

We’re all still learning about covid though and things may yet change as more evidence stacks up. Hope things go well with the planned surgery OP. (DOI: anaesthetist)

I don't think this is that new. I had to finish a course of antibiotics and be feeling better from a chest infection before a surgery a few years ago.