Risk of Acquiring Perioperative COVID-19 During the Initial Pandemic Peak: A Retrospective Cohort Study

Abstract

Objective: To determine the risk of acquiring perioperative COVID-19 infection in previously COVID-19 negative patients. Summary of Background Data: During the initial peak of the COVID-19 pandemic, there was significant concern of hospital acquired COVID-19 infections. Medical centers rapidly implemented systems to minimize perioperative transmission, including routine preoperative testing, patient isolation, and enhanced cleaning. Methods: In this retrospective cohort study, medical records of all adult patients who underwent surgery at our quaternary, acute care hospital between March 15 and May 15, 2020 were reviewed. The risk of preoperatively negative patients developing symptomatic COVID-19 within 2–14 days postoperatively was determined. Surgical characteristics, outcomes, and complications were compared between those with and without acquired perioperative COVID-19 infection. Results: Among 501 negative patients undergoing index surgeries, 9 (1.8%) developed symptomatic COVID-19 in the postoperative period; all occurred before implementation of routine preoperative testing [9/243, 3.7% vs 0/258, 0%, odds ratio (OR): 0.048, P = 0.036]. No patient who was polymerase-chain-reaction negative on the day of surgery (n = 170) developed postoperative infection. Perioperative infection was associated with preoperative diabetes (OR: 3.70, P = 0.042), cardiovascular disease (OR: 3.69, P = 0.043), angiotensin receptor blocker use (OR: 6.58, P = 0.004), and transplant surgery (OR: 11.00, P = 0.002), and multiple complications, readmission (OR: 5.50, P = 0.029) and death (OR: 12.81, P = 0.001). Conclusions: During the initial peak of the COVID-19 pandemic, there was minimal risk of acquiring symptomatic perioperative COVID-19 infection, especially after the implementation of routine preoperative testing. However, perioperative COVID-19 infection was associated with poor postoperative outcome.

Pre‐operative testing for SARS‐CoV‐2 and outcomes in otolaryngology surgery during the pandemic: A multi‐center experience

“… 19 Axiotakis et al also reported zero cases of COVID‐19 among 170 patients undergoing preoperative RT‐PCR testing preoperatively. 20 Specifically looking at studies including patients undergoing head and neck surgery, our results are also in line with a study of 47 head and neck patients in the United Kingdom in which there were no cases of COVID‐19 diagnosed. 21 …”

Patient Perceptions of COVID-19 Precautions and Their Effects on Experiences With Hand Surgery

“… 36 In our study, 77.5% of our respondents did not care or were neutral about the no-visitor policy implemented at our institution. These data are comparable to those in a Howard et al 18 study that showed 84.2% of patients undergoing elective orthopedic surgery were willing to comply with strict self-isolation for 2 weeks before and after the procedure and understood the no-visitor policy when it was explained. These results again demonstrate the willingness of patients to comply with precautions when they are adequately educated on the rationale.…”

“…25 , 26 , 27 This has likely discouraged these populations from seeking medical care, as hospitals are viewed to be COVID-19 hot spots. 18 However, recent data suggest that the implementation of preoperative COVID-19 screening and self-quarantining for elective orthopedic surgery has not been associated with any cases of COVID-19 as confirmed by polymerase chain reaction testing. 28…”

“… 12 , 13 , 14 , 15 There are also several orthopedic-specific studies that have examined patient perspectives, with most of them focusing on total joint arthroplasty. 16 , 17 , 18 , 19 These studies have shown varying impacts on patient well-being, progression of disease, and anxiety surrounding elective procedures in the COVID-19 era. It remains unclear, however, how these protocols alter the patient experience for hand and upper extremity surgery.…”

Thoracic surgery in the COVID-19 era: an Italian university hospital experience

“…The patient healed from the infection in a month and continued the oncological follow-up. Our COVID-19 infection rate was slightly lower than that shown in a previous report [ 18 ]. Reasons underlying this result are hypothetical and include an early implementation of routine preoperative testing for all the patients and subdivision of admitted patients in different wards.…”