Hip replacement and Covid. Covid Information for Consent - James Lewis Goring Hall

Information for patients undergoing surgical procedures involving anaesthesia during the COVID-19 pandemic At BMI Healthcare we are committed to your safety and supporting you to make the right decisions about your care in the light of the additional risks created by COVID-19.

This leaflet includes details about the potential impact of COVID-19 on your forthcoming operation but, please remember that a member of our team is always happy to answer questions you may have about your care.

Your surgeon and the hospital team Your surgeon will discuss the possible outcomes of the operation with you and, if appropriate your family or carers, before reaching a shared decision with you. This discussion will:

cover the benefits of having the operation, and the effects on your health and wellbeing of postponing or not having it

ensure that you understand the risks associated with COVID-19 during the operation and that you have given your informed consent

include alternative options if you wish to decline or postpone your operation

It is important that you feel well informed about the benefits and risks involved in your operation, including those that can be caused by COVID-19 before you give your consent.

Your surgeon may also wish to discuss the impact of the prevalence of COVID-19 in your local area.

You can access information about this here:

England

Scotland

Wales

Risks associated with COVID-19 Whilst the impact of COVID-19 on surgery is not yet fully understood, there is evidence that some patients undergoing surgery while they are infected with COVID-19 are at risk of developing serious complications or death during the period after surgery. A recent research study indicated that developing COVID-19 at the time of an operation could lead to a risk of death of 19%*, supporting the importance of self-isolation and testing before surgery.

There are a number of individual factors which are associated with the increased risk of becoming severely ill if you undergo an operation whilst having a COVID-19 infection. These factors include: n older age (70 or older) n being male n people from a black, Asian or other minority ethnic group n underlying health conditions such as obesity, diabetes or high blood pressure n being clinically extremely vulnerable.

There are some circumstances that might increase the risk that you are exposed to COVID-19 prior to your operation. These include: n p articular occupations, for example, work involving direct contact with multiple other people in a closed environment n particular living arrangements, for example, multigenerational households or social care environments There are some operations which carry greater risk if the person undergoing the operation is infected with COVID-19. These include: n cancer surgery n major surgery n emergency surgery

Your surgeon will consider your risk profile and advise you of the risks and benefits of the various options which are clinically suitable for you as well as the steps that you should take if you are at higher risk.

Optimising your health and wellbeing before your operation Patients who are able to improve their health and activity levels are therefore fitter and recover from surgery more quickly. Your clinical team will advise you of some of the steps that you should take to optimise your health and wellbeing before your operation.

These may include: n taking regular exercise n d oing strengthening and balance exercises n improving your mental wellbeing n reducing your alcohol consumption n stopping smoking n controlling any existing conditions You can access further information on improving your health before your operation here: https://www.cpoc.org.uk/patients

Preparation for your operation In order to protect you from COVID-19 infection and prevent spread of the virus it is important that you: n m inimise contact with others, follow comprehensive 2 metre social distancing and rigorous hand hygiene for 14 days before your operation. n have a COVID-19 test a maximum of 72 hours before your operation n observe strict self-isolation, alone or with friends or family, between the time of your test and your operation.

If you are at greater risk of getting COVID-19 or at risk of a poorer outcome if you were to get COVID-19, you may wish to self-isolate for 14 days before your operation. Please refer to the risk factors which are set out above.

On the day before your admission we will call you to ask you whether you have symptoms of COVID-19. We will also ask you whether you have symptoms of COVID-19 and check your temperature on your arrival at hospital. Before your operation we will ask you to confirm you have adhered to the guidance on social distancing and self-isolation.

Transport

Protecting you during your stay in hospital

If possible, you should use private transport to get to and from the hospital. Your Consultant or members of the healthcare team will advise you on whether you will be able to drive following your operation or whether you should arrange that a family member or friend pick you up. If you are not able to arrange private transport you should follow UK government advice on using public transport.

In order to protect you and reduce the spread of COVID-19 in our hospitals we have put in place a number of further safety measures. These include: n enhanced standards of cleaning and infection prevention n easy access to handwashing and hand sanitisers n our clinical areas are cleaned after every appointment n we ensure everyone maintains social distancing and wears a mask or face covering n all of our staff use appropriate personal protective equipment n e veryone entering our hospitals is asked to complete a short health questionnaire and have a temperature check n patients have access to on-site parking n f or those at higher risk, we ensure fast track access to the location in the hospital that you need to visit n i f you need to stay overnight you will be offered a single room for your safety and comfort n w e do not allow visitors or companions to accompany patients except in exceptional circumstances.

You can access these safety measures along with a range of further patient guides here: https://www.bmihealthcare.co.uk/coronavirus-advice/keeping-you-safe

Postponing your operation We are likely to postpone your operation if: n your test result is not available or you test positive for COVID-19 n you have symptoms of COVID-19 n are not well enough for your operation n you have had contact with someone with COVID-19, for example as identified through the NHS Test and Trace system.

If your operation is postponed you should speak to your hospital specialist team as soon as possible about rescheduling it.

Discharge arrangements Your Consultant and members of the ward team will discuss your discharge and follow up arrangements with you including advice about what you should do if you develop symptoms of infection, including COVID-19 symptoms, within three weeks of your operation.

*Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2. The Lancet May 2020

Coronavirus consent

There is a legal and professional duty that I ensure you are fully informed. Naturally this may increase anxiety somewhat and I am sorry regarding this.

With reference to the COVID19 pandemic there is a risk of infection with each human interactions. That person may appear well to themselves and others.

Typically, in a hospital environment many of these human interactions will be at close quarters and there will be multiple episodes of them.

To reduce the risk the following will be in place: In theatres, staff will wear full PPE. On the wards, all staff that patients will come into contact with will be wearing masks, aprons, gloves and visors. We will minimise the time in Hospital. I will use technology where possible.

All staff undertake Government approved lateral flow Covid self testing TWICE every week and are temperature checked on arrival to the hospital.

All staff have been offered vaccination, and thus the risk of staff carrying Covid has lessened considerably. Please note even a fully vaccinated person can still transmit Covid in the time window from catching it to the body mobilising enough antibodies to "deal" with it.

According to guidelines you will be asked to be swabbed for Coronavirus less than 72 hours days pre-admission followed by strict self isolation. Visitors are not allowed. Access to the ward is security controlled via a locked door.

Despite all the above there remains a risk of catching Coronavirus. There is of course always a risk of becoming unwell for medical reasons and being strongly encouraged to transfer to an NHS facility for medical care, where one would expect the risks of catching coronavirus to be higher. Furthermore the normal expectations of ITU support if you need it may well not be there.

The consequences of catching coronavirus includes the well known risk of death. Imperial College data states the risk of death according to age group as: 50-59 0.6% 60-69 2.2% 70-79 5.1% 80+ 9.3% The healthier one is the lower the risk, the more medical problems one has the higher the risk.

Males have slightly higher risk than females. Within the age groups above the younger the lower than the stated figure, the older it will be higher.

Incidence of risk: From the beginning of Covid, Goring Hall Hospital have treated over 5000 patients in theatres (for procedures). No patient has contacted Covid, thus the incidence of the risk is very low. However the severity of risk is now higher. The UK government and a number of sources estimate the death risk of the new variant to be about 30-40% higher than the original one. Thus the consequences of catching it are higher. It is also now more transmissable - so easier to catch and easier to pass on.

Modelling and effect of timing - strongly suggests the peak has passed for the South East, thus the incidence of risk is declining - written Jan 23 2021.

Vaccine: There is a clear rationale of delaying an elective procedure until post vaccine as it reduces the Covid risks. These are not only of death but also of Long Covid.

Long Covid (from www.nhs.uk and other sources): About 2% of people report fatigue, headaches, shortness of breath, loss/change of smell or taste, brain fog, muscle weakness, chest pain, difficulty in sleeping, heart palpations, dizziness (all hair colours), joint pain, pins and needles, depression and anxiety (that's without reading this),tinnitus, earaches, nausea, diarrhoea, stomach aches, loss of appetite, rashes, fevers, cough, sore throat.

Covid also causes stroke and heart problems, long term lung damage is also common.

We completely understand if you wish to postpone.

James Lewis 3276523 Specialist Joint Replacement Surgeon.

Written 12th May 2020, updated 23rd Jan 2021

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