The French Society of Anesthesia and Resuscitation proposes to lighten the recommendations for preoperative Covid-19 tests due to the wide vaccination coverage in France and the fact that Omicron causes less serious forms of the disease.
Systematic screening for Covid-19 before surgery is no longer recommended, wrote in a statement released on Tuesday the French Society of Anesthesia and Resuscitation (Sfar). She now recommends “a reduction in the preoperative COVID-19 screening strategy for the patients least at risk”.
New recommendations have been issued due to “two significant epidemiological changes that occurred during the year 2022”, writes the organization.
Why this relief?
On the one hand, the vaccination campaign against Covid-19 has allowed a “reduction of viral transmission and a reduction in clinical severity if an infection is however contracted”. On the other hand, Sfar highlights the “almost exclusive” circulation of the Omicron variant currently, which has “greater contagiousness” but is “responsible for fewer serious forms”.
In addition to avoiding Covid-19 contamination in the hospital, preoperative screenings prevent the patient from being at increased risk after surgery. Several studies at the start of the Covid-19 epidemic have indeed demonstrated that “patients operated on early after COVID-19 are at greater risk of postoperative complications”, recalled Sfar in January 2022.
A period of six weeks was thus recommended between the last positive test and the operation, except in cases where postponing the operation presented too great a loss of opportunity for the patient.
But data from several studies on recent cases of infections underline an absence of “significant excess risk of postoperative respiratory morbidity for certain patients” having presented a Covid-19 infection.
Not everyone is concerned
However, some patients remain at risk and are not affected by these new recommendations, because an increased postoperative danger persists in the event of contamination. Sfar thus cites symptomatic people at the time of surgery, and those deemed “at risk such as the immunocompromised”, for whom it remains recommended to carry out Covid-19 screenings before surgery.
It is important to note that these are recommendations, not obligations, as since the start of the pandemic. “A screening test by RT-PCR, by nasopharyngeal swab can actually be offered before any scheduled hospitalization by decision of the doctor before a medical intervention, but this is not a national doctrine”, declared to West France the Directorate General of Health in August 2022.
Doctors can also adapt these rules according to the cases encountered. Sfar reserves the right to modify its recommendations: this last strategy is only valid “as long as the Omicron variant (and its sub-lines BA.2, BA.4 and BA.5) is the majority circulating strain of SARS-CoV-2 in France.”
The organization also recalls that “only screening is changing, barrier measures remain present and must be applied throughout the patient journey, from consultation to critical care”.
