Informed consent for surgery during the Covid-19 pandemic 

Private hospitals around the UK have joined the NHS to ensure that truly urgent operations and treatments can be undertaken away from the front-line care of patients with Covid-19 infection.  This arrangement is expected to continue until the latter part of June.  As the first wave of infections pass, preparations are underway to re-establish more normal services.  

With continuing uncertainty whether a further wave of infections can be avoided, the resumption of planned surgery needs to be undertaken with caution and careful prioritisation of the most urgent cases.  On 11 April, the four Royal Colleges of Surgeons (England, Edinburgh, Glasgow and Ireland) provided a clinical guide that described levels of surgical priority. The Royal Colleges recommended that patients requiring surgery during the COVID-19 crisis should be classified in the following groups: 

Priority level 1a           Emergency - operation needed within 24 hours 

Priority level 1b           Urgent - operation needed with 72 hours

Priority level 2             Surgery that can be deferred for up to 4 weeks 

Priority level 3             Surgery that can be delayed for up to 3 months 

Priority level 4             Surgery that can be delayed for more than 3 months 

In the NHS, surgeons are being asked to prioritise the patients on their waiting lists according to this classification.  Most planned orthopaedic operations will be classified as priority level 3 or 4 and this does provide some leeway to delay surgery.  However, we do recognise that many orthopaedic conditions do get worse as time passes and you should alert us if you feel that your condition is deteriorating. 

Under normal circumstances, the great majority of patients can look forward to a smooth recovery from orthopaedic surgery and only a small percentage experience any kind of complication.  Surgeons are also able to provide their patients with a fairly accurate prediction regarding the chances of different complications occurring.  In contrast, the risks that relate to Covid-19 cannot be quantified.  In consequence, it is much harder to provide you with accurate information to consider.  We know that it will be some months before a vaccine against Covid-19 is released and if you decide to postpone your operation until a vaccine is available, please be reassured that we will support you as best we can while you wait.

If you decide to go ahead with surgery before a vaccine is available, there are Covid-19 specific risks that you need to consider. These include:

1)    You could have, or be developing Covid-19 infection, when you come into hospital for your operation.

2)    You could catch Covid-19 from one of the hospital staff or another patient.

3)    If you do have Covid-19 when your surgery is undertaken or if you develop Covid-19 symptoms, soon after surgery, your recovery could be prolonged and there is a risk of developing serious illness, possibly leading to admission to intensive care or death.

4)    Your recovery from surgery could be compromised if you catch Covid-19 in the first few months after your operation and you may require readmission to hospital.

We will do our best to try to minimise the risk of Covid-19 adversely affecting you.  Our plan is:

1)    To resume surgery on patients whose need is urgent and those with the fewest underlying medical conditions (like diabetes, heart disease and respiratory conditions). Hopefully, this will minimise the risk of severe symptoms if anyone does contract Covid-19 infection.

2)     We will do everything we can to prevent anyone with active Covid-19 infection being admitted to hospital.  Firstly, this will require you to self-isolate yourself for two weeks before your admission.  Secondly, you must be confident that neither you, nor anyone living with you, has had any Covid-19 symptoms in the two weeks preceding your admission. Lastly, a swab test that we will take from you in the 48hrs before your admission must be negative.

3)    The hospital has initiated a screening programme[VP2]  to check that all the staff looking after you are free of Covid-19 infection.

4)    To keep you and our staff safe, you may not be allowed any visitors whilst you are in hospital.

5)    We will not keep you in hospital any longer than necessary.

6)    You will need to self-isolate yourself for two weeks after your discharge from hospital.  This can be with your family or carers. This also means that you will not be able to see a physiotherapist while you are self-isolating. To minimise the effect of this restriction, we will provide you with instructions for the exercises that you should undertake and provide you with telephone and/or online support from our physiotherapy team.

Sadly, we cannot provide you with any hard numbers to quantify the additional risk that Covid-19 could have on the outcome of your operation, To help monitor your progress after you leave hospital we will maintain regular contact with you by telephone or an online video platform and we will encourage you to use a telephone App to record your progress. We will also need you to contact us, straight away, if you develop any Covid-19 related, or any other complications.

If you have any questions that you would like to ask before deciding whether to go ahead with your operation or to postpone until a vaccine is available please call 07468451203 or email secretary@themeskpractice.com