Recommendations for Preoperative Evaluation of
Previously COVID+ Patients for Elective Surgery
1. After first positive SARS-CoV-2 test or symptom onset if symptomatic.
2. May consider ordering based on persistent symptoms and exam findings after the
recommended wait time has elapsed.
3. Consider echo based on persistent symptoms, exam and/or elevated NT-proBNP after
the recommended wait time has elapsed.
4. Consider evaluation by Preoperative Clinic, Primary Care or specialist for persistent
symptoms after the recommended wait time has elapsed.
5. Confirmation by home rapid antigen is acceptable if patient was symptomatic at the
time of testing.
• Considerations for URGENT surgery that will be performed sooner than recommended wait time:
o If possible, patient should be cleared from isolation (10 days since onset of symptoms or 20 days
for critically ill/immunocompromised)
o If possible, patients should be symptom free for 72 hours.
o Consider escalating VTE prophylaxis given the hypercoaguable complications associated with
COVID-19
• If patients require testing by the new guidelines (high risk procedures only). Patients will not be retested
within 90 days of previous positive test unless presenting with new COVID type symptoms after resolution of
previous illness.
• For COVID vaccinated patients, ensure that they are a minimum 72 hours post vaccination and are not
symptomatic from vaccine.
Patient's COVID history
5
Minimum
delay
before
surgery
1
EKG
CBC
CMP
CXR NT-proBNP Echo
PREOP
CLINIC/PCP
EVAL
Asymptomatic SARS-CoV-2 + test 4 weeks
?
2
?
2
Mild COVID-19 (non-respiratory) 4 weeks
?
2
?
2
Moderate COVID-19 (e.g., cough,
dyspnea, prolonged fatigue,
myalgias, fever) without
hospitalization
7 weeks
?
2
?
2
?
2
?
2
X
4
Moderate-Severe COVID-19 with
hospitalization or
immunocompromise
8-10
weeks
?
2
?
2
?
2
?
2
?
3
X
4
Severe COVID-19 w/ICU 12 weeks
?
2
?
2
?
2
?
2
?
3
X
4
