key: cord-0938847-c4umij8q authors: Xavier, Ruben Gregory; Roslani, April Camilla; Draman@Yusof, Mohd Rusdi; Ng, Doris Sin-Wen; Govindaraju, Revadi; Singh, Sujaya; Tan, Chuey Chuan title: Pre-surgical COVID-19 swabs in surgical patients: An institutional experience in a middle income country date: 2021-02-15 journal: Asian J Surg DOI: 10.1016/j.asjsur.2020.11.028 sha: f23cc18e67637350d1fc28c55b210493c7333912 doc_id: 938847 cord_uid: c4umij8q nan Pre-surgical COVID-19 swabs in surgical patients: An institutional experience in a middle income country To the editor, COVID-19 has exerted tremendous pressure on the healthcare system and has inadvertently deprioritised non-emergency clinical services, including elective surgeries. As pulmonary complications and mortality rates are high in patients with perioperative SARS-CoV-2 infection, it is recommended that patients for elective surgery should be isolated for 14 days, screened with questionnaire and tested by throat swab within 72 h of surgery. 1e3 Following the approval by the Medical Research Ethics Committee (MREC ID NO: 2020618-8780), we prospectively reviewed data on all patients undergoing surgical procedures between 1st April 2020 and 31st May 2020 at University Malaya Medical Centre (UMMC) across all surgical departments, namely surgery, orthopaedic surgery, obstetrics and gynaecology (O&G), otorhinolaryngology (ENT), ophthalmology and oral maxillofacial surgery (OFMS). All pre-operative patients were subjected to have their SARS-CoV-2 RT-PCR throat swabs taken prior to surgery. For emergency cases, the PSS results need not be available prior to surgery. All patients were screened, and risk stratified as below 4 : High risk-history of contact with symptoms Moderate risk-history of contact but no symptoms Low risk-no history of contact but with symptoms Very low risk-no history of contact and no symptoms A total of 485 patients who were planned for surgical procedures had their PSS. The breakdown of cases is as per Table 1 . A large proportion of patients were of very low, low or moderate risk on risk stratification (n ΒΌ 469, 96.7%) and had a negative PSS. Of the 16 patients who were from the high-risk group, 3 patients had a positive PSS (0.6%), and these results were obtained before surgery. However, emergency surgery was not withheld when PSS results were not available and appropriate personal protective equipment (PPE) were used based on the risk stratification and institutional guidelines. Malaysia is an upper middle-income country with a population of 32 million people. Malaysia has been recognised as one of the most successful countries in the world in handling the pandemic. As the provision of surgical services was commenced, we are able to accommodate more cases for surgery, adhering to the standard operating procedures delineated by the Ministry of Health of Malaysia and the institution. The proportion of patients with positive PSS at our centre is low. As we resume surgical services to near-normal capacity, the number of patients that need to be swabbed has increased tremendously. At our centre, the cost of one SARS-CoV-2 throat swab is around RM 160 (USD 38). Each department performs their own PSS. As clinical services resume to near-normal numbers, the PSS exerts a significant strain on the existing medical services. The admission two days prior to elective surgery inevitably prolongs hospital stay and increases the bed occupancy rate. As it is difficult to rationalise the need to swab all pre-surgical patients, the PSS intensity should be guided by thorough history taking, accurate risk stratification and local epidemiological data. Focused PSS in moderate and high-risk patients will be more cost effective. The authors declare that they have no conflicts of interests. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. The Lancet Updated general surgery guidance on COVID-19 -30 Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection Surveillance of COVID-19 in the general population using an online questionnaire: report from 18,161 respondents in China Supplementary data to this article can be found online at https://doi.org/10.1016/j.asjsur.2020.11.028.