S614 Positive Pre-Procedure COVID-19 Rates Trend Downward as Community Vaccination Rates Rise

Abstract

Introduction: In response to the COVID-19 pandemic and national guidelines, UCLA Health implemented system-wide policies for resuming safe non-urgent endoscopy on 4/13/2020. These policies included mandatory COVID-19 testing 48 hours prior to all outpatient procedures. In light of declining COVID-19 cases and increasing vaccination rates in the surrounding community in early 2021, we aimed to determine the COVID-19 positive rate among outpatients presenting for elective endoscopy. Methods: UCLA health is a large, integrated health system with 5 outpatient endoscopy units. Our study cohort included all patients scheduled for ≥ 1 outpatient procedures (colonoscopy, EGD, sigmoidoscopy, manometry, pH study, small bowel enteroscopy, manometry, EUS, ERCP) who underwent pre-procedure COVID-19 testing between 4/13/2020 and 4/22/2021. We queried the electronic health record for patient data (age, sex, race/ethnicity), procedure date & type, and COVID-19 test results 48 hours prior to procedure. Our primary outcome was the pre-procedure COVID-19 positive test rate. We compared this rate to the Los Angeles (LA) County COVID-positive test rate and LA county vaccination rates over the same period. We assessed overall COVID-positive test rate by patient demographic characteristics and used univariate and multivariable logistic regression to determine factors associated with a positive test, controlling for age, sex, and race/ethnicity. Results: The study cohort included 17,278 patients, representing 18,533 total scheduled outpatient procedures (Table 1). The cumulative pre-procedure COVID-19 positive test rate in the study cohort was 0.43% (n=79) and the inconclusive rate was 0.11% (n=21). For LA County, the COVID-19 positive test rate was 1.1-15.4% and the vaccination was 1.0-57.7% during the study period (Figure 1). Hispanic race/ethnicity was significantly associated with a positive pre-procedure COVID-19 test result after adjusting for age and sex (adjusted OR: 3.22, 95% CI: 1.82-5.69). Conclusion: The positive test rate in a mandatory pre-procedure COVID-19 testing program was overall low, even during months of high community prevalence. Notably, the monthly COVID-positive rate in our cohort paralleled monthly trends in the surrounding community, and both declined as COVID-19 vaccination rates steadily increased after December 2020. Our results support new guidance to stop routine COVID-19 testing prior to endoscopy given low overall prevalence and risk of transmission.Figure 1.: Trends in UCLA Health COVID-19 positive test rate (red), Los Angeles County COVID-19 positive test rate (blue), and Los Angeles County COVID-19 vaccination rate (green) during the study period.Table 1.: Patient Characteristics and Adjusted Analysis Results. * 2173 cases with missing or unknown race/ethnicity ^ P-value was obtained from tests comparing the demographic characteristics among patients with negative, inconclusive, and positive results using chi-square or student’s t-test. £ Odds ratios were adjusted odds ratios derived from multivariable logistic regression model that included age, gender, and race/ethnicity.