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Confusion surrounding pre-operative COVID-19 testing

The president of RANZCO has moved to clarify pre-operative COVID-19 testing requirements for Melbourne eye surgery patients amid uncertainty over whether it only applies to cases involving general anaesthetic.

Dr Heather Mack, a senior associate at Eye Surgery Associates and Clinical Associate Professor of Ophthalmology at the University of Melbourne, said there are currently no uniform requirements for COVID-19 testing in Victoria for patients undergoing eye surgery.

Heather Mack.

“There has been confusion with rapidly changing directions from Department of Health and Human Services (DHHS), and many hospitals imposing their own requirements,” she said.

“Best practice is to follow the advice from your hospital, some of which are requesting COVID-19 testing to cover the rare eventuality that ophthalmic surgery patients will need to convert from sedation to general anaesthetic.”

The update comes after the Victorian Government on 14 July introduced mandatory COVID-19 testing for all public and private elective surgery patients living in metropolitan Melbourne and the Mitchell Shire. Testing is to occur approximately a week before their procedure, with patients required to adhere to strict isolation in the lead up.

Several ophthalmology practices Insight spoke to said there were unclear reports about pre-operative testing obligations.

Several private hospitals cited DHHS advice stating tests are only required for patients requiring general anaesthetic, which some ophthalmologists thought may not apply to their patients who typically undergo sedation and topical anaesthetic. Insight sought clarification from the DHHS but is yet to receive a response.

Ms Lara Helen, practice manager at multi-disciplinary ophthalmology clinic Bayside Eye Specialists in Melbourne’s Brighton East, said the practice has incorporated COVID-19 testing for surgical patients at the directive of hospitals.

She had received advice from hospitals stating that testing had been expanded to include all patients scheduled for operative or invasive procedures, regardless of the type of anaesthetic. “99.9% of our surgical cases are performed under topical or local (block) anaesthetic.  It is highly unusual for our patients to require a general anaesthetic.”

There are concerns some surgery will be cancelled due to patients breaching isolation rules prior to their operation.

Helen said although she understood the rationale behind the measure, pre-operative testing had added another layer of complication for ophthalmology practices, particularly in terms of educating patients around the importance of isolation after their COVID-19 test.

“I know of an ENT surgeon who had two big cases booked on their list. The patients did their COVID-19 tests, went home and self-isolated. When the hospital looked into their movements, they found both hadn’t isolated sufficiently and both cases were cancelled,” she said.

“There is a huge risk a patient isn’t doing the right thing despite our efforts to educate them – we stress to them that they can’t go to the supermarket, they can’t leave their home before surgery. There’s a chance of a patient here or there who’s going to be sent home, and then that’s a waste of everyone’s time – the surgeon, patient, our staff and the hospital.”

Logistical challenges 

Mack said if the jurisdiction requires COVID-19 testing, it is important that results are also reviewed pre-operatively to reduce the risk of operating on patients that turn out to be positive later that day.

“A few cases of this have been reported already in Victoria,” she said.

In terms of the broader Victorian situation, Mack said the risk to ophthalmologists looking after asymptomatic patients who are secreting SARS-CoV-2 virus (which causes COVID-19 disease) is increasing due to the rate of community transmission.

“The latest lockdowns are significantly affecting our practice. We are accustomed to practising with social distancing and hygiene, but the new requirement for masks is a logistical challenge for both patients and practices,” she said.

“Many patients are choosing to defer their appointments to reduce their COVID-19 risk, and our clinics are mainly treating emergency patients and injection patients who need ongoing care.  We are concerned that when the pandemic settles there will be a big backlog of patients requiring care for acute and chronic ophthalmic conditions.”

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