From the Guidelines
The patient's upcoming surgery should be scheduled at least 7 weeks after the diagnosis of SARS-CoV-2 infection, unless clinical urgency and risk of disease progression outweigh the risks of delayed procedures, as recommended by the most recent consensus statement 1. The 56-year-old patient is recovering from post-COVID-19 and influenza symptoms, showing significant improvement today. His previous chest X-ray was normal, and he reports communication with ENT regarding a recent CT scan. The patient is now scheduled for upcoming surgery based on those results. He denies any current concerns and mentions having a future appointment with his specialist.
Key Considerations
- The patient's improved condition indicates positive progression in his recovery journey, though continued monitoring through specialist care remains important to address any underlying issues identified on the CT scan requiring surgical intervention.
- The normal chest X-ray suggests the respiratory symptoms were not associated with significant pulmonary pathology, while the CT scan provided more detailed information leading to the surgical plan.
- According to the consensus statement 1, patients with persisting symptoms or who have more severe COVID-19, waiting beyond 7 weeks may be beneficial and personalised multidisciplinary peri-operative care plans are recommended.
- The time before surgery should be used for functional assessment, prehabilitation and multidisciplinary optimisation, as suggested by 1.
Recommendations
- 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 1.
- Vaccination several weeks before surgery will reduce risk to patients and might lessen the risk of nosocomial SARS-CoV-2 infection of other patients and staff, as recommended by 1.
From the Research
History of Present Illness (HPI)
The patient is a 56-year-old individual who has experienced persistent symptoms following COVID-19 and influenza infections.
- The patient had previously undergone a chest X-ray, which yielded normal results 2.
- Recently, the patient underwent a CT scan and is scheduled for upcoming surgery, as per the ENT specialist's recommendations.
- The patient reports feeling much better at present and denies any other concerns.
- An upcoming appointment with a specialist is scheduled.
Clinical Features and Outcomes
Studies have compared the clinical features and outcomes of patients with COVID-19 and influenza, including:
- A systematic review and meta-analysis that found the prevalence of influenza infection in patients with COVID-19 to be 0.8% 2.
- A study that compared critically ill patients with COVID-19 and influenza, finding that patients with COVID-19 had worse respiratory outcomes and higher hospital mortality rates 3.
- A comprehensive review of COVID-19 diagnosis and management, which highlighted the importance of hand hygiene, personal protective equipment, and diagnostic tools such as real-time PCR and computed tomography 4.
Persistent Symptoms and Evaluation
The patient's persistent symptoms following COVID-19 and influenza infections are a concern, as:
- A study summarized the evaluation and care of patients with persistent symptoms following acute SARS-CoV-2 infection, highlighting the need for ongoing monitoring and management 5.
- Another study reviewed the clinical aspects, diagnosis, and treatment of influenza, emphasizing the importance of accurate and rapid diagnostics to guide management 6.