What is your approach when surgeons want to stop hydroxychloroquine prior to surgery?  

I would absolutely say "do NOT stop HCQ." This is most likely a case of the surgical team mistaking HCQ for an immunosuppressant drug rather than an immunomodulatory drug. I would write a tactful "Rheumatologic Perioperative Recommendations" note where I would specifically state not to stop it ...

I have a stack of the perioperative management guidelines in my office, have shared this with patients, often giving two copies for them to share with their surgeon. Hydroxychloroquine remains in the body for several months; holding it for a week has no pharmacologic benefit. Similarly leflunomide, ...

While there is no rationale with regard to immunosuppression considerations to hold HCQ perioperatively, known effects of HCQ on platelet aggregation might be a consideration. While these effects were demonstrated in studies performed ex-vivo with known platelet aggregation agonists, there are also ...

As a rheumatologist, you are the expert on HCQ, not the neurosurgeon. This physician and their medical team need education that HCQ is not immunosuppressive and should not be stopped for surgery because of that concern.