Testing the Asymptomatic Pre-Surgical Population for Severe Acute Respiratory Syndrome Coronavirus 2

Abstract

IN RESPONSE to the coronavirus disease 2019 (COVID-19) pandemic, healthcare facilities deferred all but emergency surgeries for 12 weeks to minimize/reduce risk to patients and healthcare workers. 1-6 However, by April 2020, increased mortality for delaying necessary cardiac and thoracic procedures prompted multidisciplinary teams to determine how to restart surgical cases safely, balancing the urgent needs of patients, the reported increased morbidity and mortality of COVID-19Àpositive patients undergoing surgical procedures, 2,3,7,8 and the risk of spreading COVID-19 infection among healthcare workers. 4,6,7,9-11 Donning of personal protective equipment (PPE) by healthcare workers and screening of patients for COVID-19 infection are necessary for the success of surgery during the pandemic. 10,12 Screening includes a questionnaire regarding signs and symptoms of COVID-19, exposure to an infected person, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase polymerase chain reaction (PCR) testing with or without thoracic computed tomography (CT). 4,5,10-15 Whereas screening should be universal, PCR testing and CT imaging may not be available or, in low-prevalence areas, may not be necessary. 10,12 Furthermore, universal PCR testing for healthcare workers has not been advocated, except for those with signs, symptoms, and/or exposure. 16 Herein, the results of preoperative screening and PCR SARS-CoV-2 testing (cobas 6800 System; Roche Diagnostics, Basel, Switzerland [approved by the US Food and Drug Administration on March 2020]) at our institution during the time of the restart and ramping up of surgical cases are reported. After approval by the Lifespan Medical Systems Institutional Review Board, 14 weeks of SARS-CoV-2 PCR testing data were collected beginning at the restart of elective surgical cases in April 2020. For comparison, data also included nonsurgical patients with suspicion of infection. All patients underwent a nasopharyngeal SARS-CoV-2 PCR test (Cobas 6800 System), with the surgical group being tested within 72 hours of their procedure. Forehead temperatures were

Perioperative COVID-19 Screening at a Tertiary Ophthalmic Institution

“…A comparable study tested 36 939 patients over 14 weeks for all surgical specialties and found an overall positivity rate of 5.71%. 9 This positivity rate varied significantly in symptomatic (7.0%) and asymptomatic (0.41%) individuals. Dalvin et al 10 focused on presurgical testing in ophthalmic patients and found that 7 (0.60%) of 1173 patients tested positive for COVID-19 via PCR in presurgical screening.…”

“…Given the low positivity rates as well as the low positivity rates seen in asymptomatic patients at other institutions, universal presurgical COVID-19 testing of all patients can be viewed as a costly, low-yield exercise. 9 , 10 Even with a positive test result, most patients underwent their procedure as scheduled, generally indicating that a positive result does not affect the original surgical plan. Considering the resources needed to mitigate the spread of COVID-19 (ie, masks for all parties, sanitation supplies, time to clean rooms) and the significant decrease in procedures seen during the pandemic, this represents another added cost to the healthcare system.…”

“…[4][5][6][7][8] Several studies across multiple specialties have investigated the role of COVID-19 presurgical screening and reported low positivity rates, especially among asymptomatic patients. 9,10 Bobenchik et al 9 found that reverse transcriptase polymerase chain reaction (PCR) screening of presurgical asymptomatic individuals for all surgical specialties had a positivity rate of 5.71%. As a result of this low rate, universal testing was eliminated after 11 weeks and replaced with temperature testing and patient symptom questionnaires.…”