Questions and Answers for Patients Regarding Elective Surgery and COVID-19
Nonessential orthopaedic surgeries that were previously postponed due to the COVID-19 pandemic have now resumed across the United States. Given the recent increase in positive cases in many cities and states, however, it is unclear whether elective procedures will be suspended in certain regions going forward.
This resource was created to help address questions and concerns you may have about the impact of COVID-19 on your upcoming procedure. 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.
At this time, most facilities have resumed elective orthopaedic procedures. However, in light of the recent rise in the number of acute COVID-19 cases across the United States, it remains unclear whether the trend will be maintained.
Surgical facilities will follow federal, state, and local guidelines in making the decision to remain open 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.
Your surgeon can explain to you what precautions are in place at the facility where you will be having surgery and the procedures that you and your family will need to follow to keep everyone safe.
What precautions are taken to make sure the facility is safe?
Your hospital or outpatient surgical facility will follow extensive sterilization and sanitization procedures based on both government and industry recommendations. Facilities have high air flow and recirculation rates in the operating rooms, which helps to decrease potential disease transmission. This may mean that the time between surgical procedures could be longer than normal and that fewer surgeries might be scheduled in an operating room during a single day.
Operating room and other facility personnel are screened routinely, with the frequency depending on local conditions. Additionally, contact tracing is utilized at institutions to identify and quarantine employees that may have been exposed to COVID-19, thereby further limiting your risk. Personnel are tested for the virus if there is any question of illness.
The facility may also place limitations on whether visitors can 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 that you have had no known exposure to COVID-19 and that you have not had symptoms consistent with the disease. No test or screening is 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 that you are evaluated for symptoms of COVID-19 disease, such as a fever or cough. A number of questions will be asked to make sure that you have no history of symptoms to indicate you are actively sick. You will also 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 tested for COVID-19 several days before your surgery and undergo screening 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 concern with my preoperative evaluation?
If there is anything in your preoperative evaluation that suggests you may have COVID-19, 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 the virus.
Even if you have mild symptoms, such as a sore throat or cough, these will need to be checked regardless of the results of your COVID virus test. 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 at a minimum of 10 days from your diagnosis and are symptom-free, but you may need to wait as long as 4 to 6 weeks.
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 keep COVID-19 patients in separate areas with a dedicated 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 bring 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. This will help to minimize potential exposures to other patients and caregivers. 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 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, wear a mask when around others 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 (molecular or 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 performed by drawing a blood specimen. It should be able to tell if you have previously had COVID-19, 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. It is also possible that your level of virus was too low to be picked up on your pre-surgical test. 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 in March 2020 by the American Academy of Orthopaedic Surgeons with input and endorsement from the orthopaedic subspecialty societies listed below. In December 2020, it was updated by the AAOS Patient Safety Committee to include the most recent information available about the continued impact of COVID-19 on elective surgeries
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
AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.