Information for surgical patients during the coronavirus pandemic
Over the past two months, the UK has been responding to the rapid spread of COVID-19 (coronavirus) across the country. Hospitals have postponed non-emergency operations to avoid putting patients at risk and ensure that hospital resources, beds, and equipment are available to treat patients who are critically ill with COVID-19.
Following the recent announcement by the NHS to gradually reintroduce planned operations, we have produced advice for patients waiting for surgery to address concerns and provide guidance on how you can prepare for your operation.
1. When will my operation be rescheduled?
If your planned surgery was postponed during the last two months, you will now be on a waiting list. You will be contacted in due course to arrange a new date for your operation. The timing will vary depending on demands and pressures and facilities in different hospitals in the UK.
Your surgical team will discuss with you the benefits and risks of surgery as part of your shared decision-making, before going ahead with your operation. This will include consideration of any risk to you from delaying treatment. If you are in a high-risk group for contracting COVID-19, or if you have serious underlying medical conditions, it may be suggested that your operation is deferred until later, when it would be safer for you.
2. What is my risk of getting COVID-19 while in hospital?
It is currently not possible to entirely eliminate the risk of catching COVID-19 while you are in the hospital. However, hospitals are taking every possible measure to minimise your risk of infection. This includes training hospital staff on how to limit the spread of the virus through frequent hand-washing and social distancing within the hospital; regular deep cleaning; use of personal protective equipment; testing staff and patients for COVID-19; and treating patients who have symptoms or who have tested positive for COVID-19 in separate units or areas.
Should you contract the virus while having an operation, the evidence suggests that your clinical outcomes from the operation could be worse than what we would have expected before the pandemic. This is a risk that your surgical team will consider very carefully and discuss with you before recommending that any planned operation goes ahead.
3. How should I prepare for my operation?
a. What to do if you are offered a new date for your operation
If you have concerns about the timing of your operation, you should discuss these with your surgeon. You might want to ask about:
- the benefits and risks of the procedure;
- the risks of catching COVID-19;
- your risk from any pre-existing medical conditions;
- the possible side effects of the proposed operation;
- alternative options for treatment, including non-surgical care or no treatment;
- advice on your lifestyle patterns that may reduce your risk of complications after surgery or may change the progress of your condition;
- any further treatment after the operation that will be required (eg physiotherapy) and how you will access it.
b. Virtual consultations
Whether you are having a discussion about a rescheduled operation or having your initial pre-operative assessment with a member of the surgical team, this consultation may take place online or by phone, rather than face-to-face, to limit the number of people coming to hospitals while COVID-19 is still present in our community. Visits to hospital must only occur when absolutely necessary, such as when urgent scans or other examinations are required.
c. COVID-19 testing
Before you are admitted to hospital, you are likely to be asked to undergo a 14-day self-isolation period at home. Anyone who lives with you will need to do the same. Prior to admission to hospital, you will be asked about symptoms of COVID-19 such as high temperature, continuous cough, shortness of breath or loss of taste or smell, and you will normally also have a COVID-19 swab test.
If you are suspected or confirmed to have COVID-19, your operation will only go ahead if it is urgent, based on the severity of your condition and only with your consent. This is to minimise the risk of complications. Even though the diagnosis of COVID-19 may cause a further delay to your surgery, this may still be a safer option.
d. What you can do to minimise the risks of your surgery
There are steps you can take yourself to prepare for surgery and minimise the risk of complications from your operation, by improving your health and adopting a healthier lifestyle. This can improve the outcomes of your operation and reduce your recovery time. In some types of surgery, this might also allow you to be treated as a day-case, where you can leave the hospital on the same day of the operation.
4. What will happen when I am in the hospital?
a. Separate areas for patients with COVID-19
Many hospitals are identifying separate facilities to treat patients admitted for surgery where all patients and staff are regularly screened for COVID-19. However, depending on your condition and what facilities are needed to treat you, the location of your treatment will have been carefully selected. If you contract COVID-19 while you are in the hospital, you will be transferred to facilities that are equipped to manage COVID-19 patients.
b. Personal protective equipment (PPE)
When you are in hospital, you may be asked to wear a mask or other type of personal protective equipment (PPE) and most staff will be wearing some kind of PPE, too. Depending on the area in the hospital, this could be a mask, a visor or goggles, a plastic apron or full coveralls. It will most likely mean that the faces of those treating you will be covered. Please do not let this stop you communicating with staff as you normally would. If you find it difficult to hear or understand what is being said through the PPE, please make staff aware, so that they take this into account and provide alternative ways of communicating with you.
Visitors to patients in hospitals are most likely not to be allowed at this time, to minimise the risk of infection. In exceptional circumstances, visitors who are allowed in hospital premises will be asked to wear protective equipment. Most hospitals encourage patients to use phone and video calls to communicate with friends and relatives during their hospital stay. Before going to hospital, consider how you will communicate with your family and friends and make sure you have the equipment to do this and you know how to use it. You should follow the local advice of your hospital at all times.
5. What will happen after my operation?
a. Recovery and discharge
After your operation, you will be able to recover in the regular surgical ward. If you have tested positive for COVID-19, you may be moved to a different ward separately from other patients.
The length of time you spend in the hospital will depend on the complexity of your operation and the speed of your recovery. For some operations, when there are no complications, you will be able to leave the hospital on the same day. You should discuss with your surgical team what help you may need upon leaving hospital.
b. Returning home and rehabilitation
When you are discharged from hospital, you will normally return to your home. You should have a contact number from your surgical team where you can seek advice if you have any concerns. If you need to spend time in rehabilitation or need services such as physiotherapy, district nursing or occupational therapy, the same infection prevention measures outlined above will be used in these facilities.
You should make sure that you follow the instructions in your discharge letter and remain in contact with your GP, who will be aware of any ongoing care or nursing you might need at home. If needed, home visits will be arranged as part of your discharge plan to ensure you are making good progress. There may be local volunteer groups that can also help with practical matters such as shopping, or your local shops may be able to provide orders for delivery by phone or email.
c. Follow up appointments
Before you leave the hospital, you should try to find out your options for any follow-up appointments and post-operative visits that you may need. Unless further treatment is needed (eg chemotherapy), or there are complications after your operation, follow-up appointments will usually take place via video, or over the phone, to reduce the risk of infection. You can speak with your GP in the same way.
Further resources for surgical patients
- Information from the British Association of Urological Surgeons
- Information from the British Orthopaedic Association
- Information from the Royal College of Anaesthetists
- Information from the Centre for Perioperative Care