key: cord-0840085-hwm3nkdx
authors: Kavanagh, F G; Brinkman, D; James, D L; O’Neill, S; Murphy, C; O’Riordan, I; O’Flanagan, G; Lang, B; Keogh, I; Lang, E; Casserly, P; Russell, J; O’Brien, D; Sheahan, P
title: Outcomes of preoperative real-time polymerase chain reaction testing for SARS CoV-2 in elective otolaryngology surgical patients during the pandemic: a prospective cohort study
date: 2021-08-24
journal: Br J Surg
DOI: 10.1093/bjs/znab266
sha: b59184b2b0300fa45125ce7ab120babc74bc7135
doc_id: 840085
cord_uid: hwm3nkdx

Real-time polymerase chain reaction (RT-PCR) is used to rule out SARS-CoV-2 prior to surgery, however few studies have evaluated patients with negative testing after surgery. Some 499 patients with negative tests were followed for 14 days after surgery, 39 were retested but none developed positive RT-PCR after operation. The risk of developing a positive RT-PCR after surgery was 0.74 per cent.

Preoperative real-time polymerase chain reaction (RT-PCR) testing has become widely used as a means of excluding SARS CoV-2 prior to elective surgery 1 . Most data on preoperative patients have focused on SARS-CoV-2 detection, but without comprehensive follow-up of patients to assess the risk of transitioning to a COVID-19-positive status in the postoperative period 2 . Among asymptomatic patients, an RT-PCR test may be falsely negative if performed too early in the disease incubation period 3 . The authors wished to evaluate the outcome of preoperative RT-PCR testing prior to elective otolaryngological surgery, with systematic follow-up of all patients at 14 days, to capture cases transitioning to symptomatic COVID-19 in the postoperative period.

A prospective cohort study was carried out at five sites in the Republic of Ireland. Ethical approval was granted by the National Research Ethics Committee (20-NREC-COV-087). Patients presenting for elective otolaryngology surgery from 2 September to 18 December 2020, with negative preoperative RT-PCR (AllplexTM 2019 nCoV Assay, Seegene Inc.) swabs, taken within 72 hours of hospital admission, were eligible for inclusion. Study data were collected prospectively and managed using the REDCap TM (Royal College of Surgeons, Ireland) electronic datacapture tool. Participants were contacted 14 days after surgery and answered a questionnaire. The 14-day community prevalence data were obtained from the Health Surveillance Protection Centre. The primary outcome measure was a postoperative diagnosis of COVID-19. Secondary outcome measures were occurrence of major respiratory complication (defined as need for hospital readmission) or any respiratory symptoms. Statistical analysis was performed with Stata Release 16 TM . Where zero frequencies were observed, only the upper confidence limit is reported.

From 1911 eligible patients, 638 were approached for inclusion. Of these, 499 consented to be included in the 14-day followup. Demographics and operative details are presented in Table 1 . During the inclusion period, 10 patients had positive preoperative tests for SARS-CoV-2, giving a yield rate of 0.5 per cent. The peak community incidence of new COVID-19 cases was 302.9 per 100 000 (14-31 October 2020).

At 14-day follow-up, no COVID-19 infections were reported. Thirty-nine patients underwent further RT-PCR testing (all negative) due to hospital readmission for post-tonsillectomy bleed or other complications (20 patients), respiratory symptoms (6 patients), prolonged in-patient stay (5 patients), occupational reasons (5 patients) and close contact to confirmed cases (3 patients). Furthermore, 18 patients had respiratory symptoms but were not retested because they did not seek medical advice (16 patients) or the attending doctor felt they did not meet testing criteria (2 patients). There were no major respiratory complications. The upper 95 per cent confidence limit of developing symptomatic COVID-19 infection was estimated at 0.74 per cent.

These findings suggest that patients with negative preoperative RT-PCR tests have a low risk of transitioning to symptomatic 

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