Low prevalence (0.13%) of COVID-19 infection in asymptomatic pre-operative/pre-procedure patients at a large, academic medical center informs approaches to perioperative care

Abstract

Background The COVID-19 pandemic has resulted in reduced performance of elective surgeries and procedures at medical centers across the U.S. Awareness of the prevalence of asymptomatic disease is critical for guiding safe approaches to operative/procedural services. As COVID-19 PCR testing has been limited largely to symptomatic patients, healthcare workers (HCWs), or to those in communal care centers, data regarding asymptomatic viral disease carriage are limited. Study Design In this retrospective observational case series evaluating UCLA Health patients enrolled in pre-operative/pre-procedure protocol COVID-19 RT-PCR testing between 4/7/20 – 5/21/20, we determine the prevalence of COVID-19 infection in asymptomatic patients scheduled for surgeries and procedures. Results Primary outcomes include the prevalence of COVID-19 infection in this asymptomatic population. Secondary data analysis includes overall population testing results and population demographics. 18 of 4751 (0.38%) patients scheduled for upcoming surgeries and high risk procedures had abnormal (positive/inconclusive) COVID-19 RT-PCR testing results. 6/18 patients were confirmed asymptomatic. 4/18 had inconclusive results. 8/18 had positive results in the setting of recent symptoms or known COVID-19 infection. The prevalence of asymptomatic COVID-19 infection was 0.13%. More than 90% of patients had residential addresses within a 67 mile geographic radius of our medical center, the median age was 58, and there was equal male/female distribution. Conclusions These data demonstrating low levels (0.13% prevalence) of COVID-19 infection in an asymptomatic population of patients undergoing scheduled surgeries/procedures in a large urban area have helped to inform perioperative protocols during the COVID-19 pandemic. Testing protocols like ours may prove valuable for other health systems in their approaches to safe procedural practices during COVID-19.

Clinical and Epidemiologic Evaluation of Inconclusive COVID-19 PCR Results Using a Quantitative Algorithm

“…5 Although asymptomatic infection has been documented in previous studies, 6 the PCR-positive rate among asymptomatic individuals is not expected to be high, considering the overall PCR-positive rate in our institution ranged from 2.1% to 5.4%, and the presurgical screening positive rate is only 0.13%. 7 A massive scale of asymptomatic testing by PCR, such as for the purpose of preadmission and presurgical screening, will inevitably lead to false-positive results. Therefore, having multiple PCR targets in an assay and reporting an “inconclusive” result if only one target is detected is advantageous, especially in a setting of low pretest probability.…”

Should Covid-19 RT-PCR Test Be Performed Before Elective Cataract Surgery? A study In the Light of Prevalence and Cost Analysis

“…A study from the United States of America, which investigated the seroprevalence of Covid-19 infection in asymptomatic preoperative/pre-procedure patients, reported the seroprevalence of the disease was 0.13%. 12 The most similar study was conducted in India by Kannan et al…”

Interventional pain management during SARS-CoV-2 pandemic

“…PCR screening of asymptomatic populations prior to surgery/interventions has revealed a SARS-CoV-2 positivity rate of 0% to 13.7% [13][14][15][16][17]. These differences in reported rates of positivity have been attributed to the fact that "the incidence of subclinical infection may probably vary according to the prevalence rates in different communities [16].…”