Preoperative Universal SARS-CoV-2 Screening for Asymptomatic Patients: A Report From Tokyo, Japan

Abstract

Coronavirus disease 2019 (COVID-19) is associated with considerable perioperative mortality.1Nepogodiev D. Bhangu A. Glasbey J.C. et al.Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: An international cohort study.Lancet. 2020; 396: 27-38Abstract Full Text Full Text PDF PubMed Scopus (1018) Google Scholar Preoperative COVID-19 screening is recommended for all patients before elective surgery to decrease perioperative mortality and avoid secondary infection from asymptomatic patients.2Ortoleva J. Dalia A.A. Preoperative COVID-19 testing for cardiovascular procedures in endemic areas should be mandatory.J Cardiothorac Vasc Anesth. 2020; (Accessed August 25, 2020. [e-pub ahead of print])https://doi.org/10.1053/j.jvca.2020.07.080Abstract Full Text Full Text PDF Scopus (2) Google Scholar,3American Society of Anesthesiologists. ASA and APSF statement on perioperative testing for the COVID-19 virus. Available at: https://www.asahq.org/-/media/files/spotlight/asa-and-apsf-statement-on-perioperative-testing-for-the-covid-19-virus-june-3.pdf?la=en&hash=F77342E667AF5CBE503D8597A5B6894DAB2FBC66. Accessed September 1, 2020.Google Scholar The evidence of routine preoperative screening, however, is unclear and available data are scarce. Herein, we report the results of universal screening of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) before elective surgery. We conducted COVID-19 screening using nasopharyngeal SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) between May 21 and August 1, 2020, for patients planning elective surgery at Juntendo University Hospital, which has 1,051 beds and annually performs >10,000 surgeries with general anesthesia. All samples were obtained by well-trained doctors within five days before surgery. RT-PCR was performed using LightMix Modular SARS-CoV (COVID-19) 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 two 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, were 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 surgery was postponed. She stayed home and was asymptomatic for more than 14 days during the observational period. Among negative patients, 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 between January 14 and 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 varied by region,4Oran D.P. Topol E.J. Prevalence of asymptomatic SARS-CoV-2 infection: A narrative review.Ann Intern Med. 2020; 173: 362-367Crossref PubMed Scopus (1166) Google Scholar possibly because of 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, suggested that careful history taking may be sufficient for COVID-19 screening in low infection areas. There were limitations to this study. Primarily, our study reported data from one region with low infection rates; thus, our findings may not be applicable in high-prevalence areas. Additional studies are warranted to confirm the usefulness of universal screening in high COVID-19-prevalent areas. None.