Mandatory preoperative COVID‐19 testing for cancer patients—Is it justified?

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 has caused substantial disruptions in routine clinical care. Emerging data show that surgery in coronavirus disease (COVID)-positive cases can be associated with worsening of clinical outcomes and increased postoperative mortality. Hence, preoperative COVID-19 testing for all patients before elective surgery was implemented in our institution. Materials and Methods: Two hundred and sixty-two asymptomatic cancer patients were preoperatively tested for COVID-19 using reverse-transcription polymerase chain reaction technique with nasopharyngeal and oropharyngeal swabbing. All negative patients were operated within 72 hours, and positive patients were quarantined for a minimum 14 days before re-swabbing. Results: In our cohort, 21 of 262 (8.0%) asymptomatic preoperative patients, who were otherwise fit for surgery, tested positive. After adequate quarantine and a negative follow-up test report, 12 of 21 (57%) had an operation. No major postoperative morbidity due to COVID-19 was noted during the immediate postoperative period before discharge from the hospital. Conclusion: Routine preoperative COVID-19 testing was successful in identifying asymptomatic viral carriers. There was no incidence of symptomatic COVID-19 disease in the postoperative period, and there was no incidence of morbidity attributable to COVID-19. These data suggested a beneficial role for mandatory preoperative COVID-19 testing.

Surgical Outcomes During COVID-19 Pandemic

“…Interestingly, a careful preoperative screening methodology in elective surgical oncology patients resulted in a low COVID-19 infection in our series (2.1%, n = 2). Some other authors have justified our strategy having similar results ( 28 , 29 ).…”

Short Term Outcomes of Head and Neck Oncology Surgery During Covid-19 Pandemic: Experience from a Tertiary Cancer Care Centre in North India

“…Importantly, none of the patients in our study developed any signs or symptoms suggestive of COVID-19 requiring testing during post-operative period. This was also the case in study reported by Nekkanti et al where none of the patients developed any signs of COVID-19 infection [4].…”

“…In this study, the authors concluded that with pre-operative screening of patients, head and neck cancer surgery can be performed safely during the pandemic [6]. A study conducted by Nekkanti et al at Tata Memorial Hospital; Mumbai also suggested that pre-operative testing has a beneficial role in giving good post-operative outcomes [4]. There was also a strong recommendation for doing the same by a recent consensus guideline for head and neck cancer management [2].…”

“…With regards to free flap reconstruction, we too have been inclined to do more pedicle or local flaps but have done free flaps as and when required ( Table 1). There were initial reports of poor surgical outcomes in oncology patients who tested positive for COVID-19 in post-operative period [4]. We have been following strict symptom-based screening in initial period of pandemic when the test was not available.…”

“…This risk continues even in the post-operative period especially in the patients who are tracheostomized or have undergone laryngectomies [3]. Moreover, there are reports of poor surgical outcomes and increased post-operative mortality in patients who had COVID-19 infection [4].…”