Screening and testing for COVID‐19 before surgery

Abstract

Background: Preoperative screening for coronavirus disease 2019 (COVID-19) aims to preserve surgical safety for both patients and surgical teams. This rapid review provides an evaluation of current evidence with input from clinical experts to produce guidance for screening for active COVID-19 in a low prevalence setting. Methods: An initial search of PubMed (until 6 May 2020) was combined with targeted searches of both PubMed and Google Scholar until 1 July 2020. Findings were streamlined for clinical relevance through the advice of an expert working group that included seven senior surgeons and a senior medical virologist. Results: Patient history should be examined for potential exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Hyposmia and hypogeusia may present as early symptoms of COVID-19, and can potentially discriminate from other influenza-like illnesses. Reverse transcription-polymerase chain reaction is the gold standard diagnostic test to confirm SARS-CoV-2 infection, and although sensitivity can be improved with repeated testing, the decision to retest should incorporate clinical history and the local supply of diagnostic resources. At present, routine serological testing has little utility for diagnosing acute infection. To appropriately conduct preoperative testing, the temporal dynamics of SARS-CoV-2 must be considered. Relative to other thoracic imaging modalities, computed tomography has the greatest utility for characterizing pulmonary involvement in COVID-19 patients who have been diagnosed by reverse transcription-polymerase chain reaction. Conclusion: Through a rapid review of the literature and advice from a clinical expert working group, evidence-based recommendations have been produced for the preoperative screening of surgical patients with suspected COVID-19.

Advantages of, and Adaptations to, Enhanced Recovery Protocols for Perioperative Care during the COVID-19 Pandemic

“…A 14-day quarantine before surgery should be considered for patients who are asymptomatic but with a history of potential exposure to the virus to allow time for presentation of the symptomatic phase. Repeat testing up to 48 hours before discharge to a group care facility should be considered [ 42 , 43 ].…”

Proposed delay for safe surgery after COVID‐19

“…In a similar fashion to previous publications, 1,4,15,16 a rapid review of the literature was combined with advice from a working group of clinical experts across Australia and New Zealand 17,18 . The working group comprised seven senior surgeons (one urologist and six general surgeons), two senior anaesthetists and a senior medical virologist.…”

“…High mortality and pulmonary complications associated with perioperative severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection 3 have modified both preoperative risk–benefit assessment and postoperative care. Appropriate screening and testing for SARS‐CoV‐2 have become crucial 4 . Ongoing risks of nosocomial spread to both surgical staff and patients have disrupted surgical systems on a global scale 5…”

Postoperative inflammation to “hyper”‐inflammation: cryptic COVID‐19 connections!

“…the situation furthermore. 5,6 The preoperative testing recommendations cite the lack of cost-effectiveness of a routine preoperative antibody screening in addition to a considerably variable seroprevalence rate. 6 As an extension of our discussion of a cryptic preoperative COVID-19 infection "hiding in the shadows," the shadows are unfortunately only expected to turn murkier as we navigate further into the pandemic with more elective surgical settings being reopened.…”