key: cord-0866846-oqlvq50c
authors: Komori, Akira; Mori, Hirotake; Kojima, Yutaka; Tabe, Yoko; Naito, Toshio
title: Preoperative Universal SARS-CoV-2 Screening for Asymptomatic Patients: A Report From Tokyo, Japan
date: 2020-10-10
journal: J Cardiothorac Vasc Anesth
DOI: 10.1053/j.jvca.2020.10.008
sha: 54cdc411d75baef1971008acf2989ee6319e0fcf
doc_id: 866846
cord_uid: oqlvq50c

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Coronavirus disease 2019 is associated with considerable perioperative mortality. 1 Preoperative COVID-19 screening is recommended for all patients prior to elective surgery to decrease perioperative mortality and avoid secondary infection from asymptomatic patients. 2, 3 The evidence of routine preoperative screening, however, is unclear and available data are scarce.

Here, we report the results of universal screening of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prior to elective surgery.

We conducted COVID-19 screening using nasopharyngeal SARS-CoV-2 reverse transcriptase PCR (RT-PCR) during May 21-August 1, 2020, for patients planning elective surgery at Juntendo University Hospital, which has 1,051 beds and performs >10,000 surgeries under general anesthesia annually. All samples were obtained by well-trained doctors within 5 days prior to operation. RT-PCR was performed using LightMix Modular SARS-CoV (COVID19) N-gene and E-gene assays (Roche Diagnostics, Japan) or the 2019 Novel Coronavirus Detection Kit (Shimadzu, Japan). We included all patients planning elective surgery under general anesthesia and excluded patients who met the following criteria: febrile or cold symptoms, unexplainable fatigue, shortness of breath, anosmia or dysgeusia, history of close contact with patients confirmed or suspected of having COVID-19 and history of international travel within 2 weeks.

A total of 1,376 patients, including 117 (8.5%) patients planned for thoracic surgery and 53 (3.9%) patients planned for cardiovascular surgery, was examined. The mean age was 57.9 years and 632 (45.9%) patients were male. Among them, only one female patient had a positive result.

Her medical history included pancreatic tumor, Peutz-Jeghers syndrome, cervical cancer and breast cancer. Her operation was postponed. She stayed home and was asymptomatic for more than 14 days during the observational period. Among negative cases, no one was diagnosed with COVID-19 during admission.

Tokyo, with a population of approximately 14 million people, has the highest incidence of COVID-19 in Japan, reporting 17,609 confirmed COVID-19 cases during January 14-August 15, 2020. During this period, the SARS-CoV-2 positivity rate in Tokyo gradually increased from 0.8% to 6.7% (Fig. 1) .

Universal preoperative screening using SARS-CoV-2 RT-PCR for asymptomatic patients in a single metropolitan hospital revealed extremely low positivity rates. COVID-19 prevalence among asymptomatic patients varies by region, 4 possibly due to the difference in infection rates in the area. COVID-19 infection in patients undergoing thoracic and cardiac surgery can lead to high mortality; therefore, universal COVID-19 screening is recommended. Our study, however, suggests that careful history taking may be sufficient for COVID-19 screening in low infection areas. There are limitations to this study. Primarily, our study reports data from one region with low infection rates; thus, our findings may not be applicable in high prevalence areas. Further studies are warranted to confirm the usefulness of universal screening in high COVID-19 prevalent areas.

Mortality and Pulmonary Complications in

Patients Undergoing Surgery with Perioperative SARS-CoV-2 Infection: An International Cohort Study

Preoperative COVID-19 Testing for Cardiovascular Procedures in

Endemic Areas Should be Mandatory

ASA and APSF Statement on Perioperative Testing for the COVID-19 Virus

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Prevalence of Asymptomatic SARS-CoV-2 Infection: A Narrative Review

SARS-CoV-2 Positivity Rate in Tokyo

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.