Since the publication of an increase in perioperative morbidity and mortality up to 6 weeks after infection with COVID-19 by the COVIDSurg Collaborative,1 many hospitals worldwide have adopted policies of post COVID waiting periods before elective surgery may be performed. However, the introduction of such ‘exclusion times’ has the potential to significantly interrupt the flow of elective surgery,2 and the postponement of surgery due to COVID has been shown to have a negative impact on emotional wellbeing and the perception of the quality of life.3 The findings of the COVIDSurg group included a heterogenous group of patients, many of whom likely infected with either the original COVID strain or the Delta variant, and many patients were either unvaccinated or only partially vaccinated. This invites the question whether in a highly vaccinated population and with the predominance of the Omicron variant outcomes after surgery may be different. The current vaccination rate for 2 or 3 doses of a COVID vaccine in Australia's general population is approx. 96% and 72%, respectively. Western Australia experienced a surge of COVID (vast majority Omicron) infections between February and September 2022. At the Royal Perth Hospital (RPH), the trauma centre of Western Australia, some patients underwent surgery during their active COVID infection due to the urgency of their condition. The aim of an audit done by us at the end of 2022 (approved by the Royal Perth Hospital on 14/10/2022, approval number 47637) was to identify all cases operated at RPH during this period. We then followed up their postoperative outcomes in order to identify whether the acute COVID infection was associated with an increase in postoperative morbidity or mortality. Patients were counted as COVID positive if either a positive rapid antigen test or a polymerase chain reaction test had been performed prior to their surgery. Patients undergoing cardiac or pulmonary interventions were excluded. Thirty-eight patients (median age 42 years) were identified. Two percent of patients had received four COVID vaccines, 50% percent of the patients were triple vaccinated, 32% double vaccinated, and 16% had received a single dose. Sixty-one percent of patients were classified as ASA 3 or 4, with 63% of patients having at least 2 cardio-pulmonary significant co-morbidities. Fifty-five percent presented with a fever (≥38°C) and cough. Seventy-four percent of the patients underwent surgery within 4 days of their COVID-19 diagnosis, with the majority having surgery on day two of the COVID-19 diagnosis. Eighty-two percent of the patients underwent general anaesthesia, with the seven remaining cases comprised of five regional blocks, one neuraxial anaesthesia and one case done under infiltration (local) anaesthesia. Of interest, only one of the 38 patients suffered a likely COVID-related complication, manifested as postoperatively diagnosed COVID pneumonitis. This patient was a 48-year-old female (active smoker with a past medical history of chronic obstructive pulmonary disease) who developed increasing oxygen requirements shortly after surgery. However, the patient recovered after a short course of anti-viral treatment. All 38 patients who underwent surgery during an active COVID infection were successfully discharged from the hospital. Though all but one patient had no complication after surgery, our follow-up ended at the time of hospital discharge. Hence, complications may have been missed if only occurring after this time point. However, on 30-day follow-up the mortality in our cohort was 0 %, at least indicating no extremes of impaired outcomes were missed. We conclude that the rate of postoperative complications in a relatively co-morbid cohort of patients with active COVID infection at the time of their emergency/urgent surgery was very low. Though our relatively small case series may not allow final conclusions, it may at least introduce the hypothesis that, in a highly vaccinated population and predominance of a milder COVID strain, the currently frequently observed 6–8 weeks after COVID infection until elective surgery can be performed may be overly cautious, and that an increase in surgical wait times may ultimately adversely affect patient physical and emotional health. Open access publishing facilitated by The University of Western Australia, as part of the Wiley - The University of Western Australia agreement via the Council of Australian University Librarians. Calvin Lo: Conceptualization; data curation; investigation; methodology; project administration; software; writing – review and editing. Thomas Ledowski: Conceptualization; data curation; formal analysis; investigation; methodology; project administration; supervision; writing – original draft; writing – review and editing.