key: cord-0718158-n9v0s0cv
authors: KELLY, Jeannie C.; RAGHURAMAN, Nandini; PALANISAMY, Arvind; STOUT, Molly J.; CARTER, Ebony B.
title: Pre-procedural asymptomatic COVID-19 in obstetric and surgical units
date: 2020-09-21
journal: Am J Obstet Gynecol
DOI: 10.1016/j.ajog.2020.09.023
sha: acdce10a84b9397a6edcbc10ce8d9ed3a12e40f5
doc_id: 718158
cord_uid: n9v0s0cv

nan

Asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection 31 remains a challenge, accounting for nearly half of all infections. 1 Infectivity of asymptomatic 32 patients can extend past 14 days, and samples isolated from their respiratory tracts have similar 33 viral loads to symptomatic patients. 1, 2 To mitigate surgical risk to patients and exposure of 34 healthcare workers (HCW), universal testing for SARS-CoV-2 has been suggested for all 35 patients prior to planned procedures, 3 including delivery, 4 regardless of symptoms. Pre-36 procedural asymptomatic infection (PAI) rates in Obstetrics have been reported has high as 37 14%, 4 but is unknown in the general surgical population. We sought to compare SARS-CoV-2 38 PAI rates between the obstetric unit (OU) and surgical units (SU) in one urban tertiary center. 39

We conducted a retrospective cohort study of universal pre-procedural SARS-CoV-2 41 tests performed before any surgery or delivery at Barnes-Jewish Hospital from May 28 -July 22, 42 2020, after resumption of elective cases. The study was deemed exempt as a quality 43 improvement initiative. The primary outcome was rate of SARS-CoV-2 PAI, compared between 44 an 18-bed OU and 72-room SU. All positive cases underwent chart review to confirm 45 asymptomatic presentation. Multivariable logistic regression was used to adjust for confounders 46 including age and race. Statistical analyses were conducted in R v4.0.2. 5

5543 pre-procedural tests were performed: 532 (9.7%) obstetric and 5011 (90.4%) 49 surgical (Table a) . Obstetric patients were younger (median age 29.0 vs 56.0, p<0.001), with a 50 greater proportion of females (100% vs 50.4%, p<0.001) and Black (40.4% vs 22.7%) or 51

Hispanic (9.4% vs 1.5%) race (p<0.001). Overall, there were 39 (0.7%) cases of PAI (25/532, 52 J o u r n a l P r e -p r o o f 5 4.7% OU vs. 14/5011, 0.3% SU; p<0.001). After adjusting for age and race, obstetric patients 53 had significantly higher odds of SARS-CoV-2 PAI compared to surgical patients (aOR 4.7, 95% 54 CI 2.3-10.6). After excluding males, the odds of PAI remained significantly higher in the OU 55 (aOR 9.6, 95% CI 92.8-48.3, Table b ). 56

The SARS-CoV-2 PAI rate is 15.7 times higher on the OU (4.7%) compared to the SU 58 (0.3%) in one hospital. A significant difference persists after accounting for age, race, and sex. 59

As hospitals resume normal surgical volume and enact universal pre-procedural testing policies, 

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