Preoperative COVID-19 Research Articles

The Use of Preoperative Clinical Risk Assessment in COVID-19 Screening among Asymptomatic Individuals, its Cost-effectiveness and Impact on Surgical Outcomes and Management Decisions: A Rapid Review

Objective. This rapid review aimed to summarize data on the accuracy, benefits, harms, and cost-effectiveness of preoperative COVID-19 clinical risk assessment for asymptomatic individuals. Methods. A comprehensive search in MEDLINE, Cochrane CENTRAL, ChinaXiv, medRxiv, and bioRxiv was done until March 10, 2021, using the keywords “COVID-19”, “surgery”, “RT-PCR”, “clinical risk assessment” and “cost-effectiveness”. We searched for studies that assessed the diagnostic accuracy of preoperative clinical risk assessment in COVID-19 screening among asymptomatic individuals, its cost-effectiveness, and its impact on surgical outcomes and management decisions. Risk of bias was assessed using Evaluation of Articles on Diagnosis (Painless Evidence Based Medicine)10 for accuracy studies, Newcastle-Ottawa Scale11 for cohort studies, and Drummond’s checklist12 for economic evaluations. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the overall evidence. Data from included studies were collated qualitatively using summary tables and analyzed in Review Manager 5.4. Pooling of sensitivity and specificity, odds ratio or adjusted odds ratio, and cost-effectiveness measures using a random-effects model was planned. Heterogeneity was determined using I2. Subgroup and sensitivity analyses were preplanned in case significant heterogeneity was found. Results. Three observational studies were included. Preoperative clinical risk assessment for COVID-19 demonstrated a sensitivity of 0.42 (95% CI 0.15-0.72) and a specificity of 0.85 (95% CI 0.76-0.92), using RT-PCR as a reference standard. Indirect evidence showed that any positive clinical risk assessment, COVID-19 antigen or RT-PCR test is done within 0–7 weeks from surgery was associated with a higher 30-day postoperative mortality (RR 3.96, 95% CI 3.41, 4.59) and pulmonary complications (RR 3.41, 95% CI 3.04, 3.83). Delaying surgery at least seven weeks from COVID-19 diagnosis was associated with lower post-surgical complications. Universal pre-endoscopy virus testing using the antigen rapid diagnostic test (Ag-RDT) (ICER = -26,286 €), standard RT-PCR (ICER = -11,128€), or rapid PCR (ICER = -13,703 €) combined with high-risk personal protective equipment (PPE) use in all patients irrespective of test results were found to be more cost-effective compared to no pre-endoscopy testing and no high-risk PPE use, at an, assumed COVID-19 prevalence of 1% or higher among asymptomatic individuals. Overall certainty of evidence was very low. Conclusion. Preoperative clinical risk assessment has poor sensitivity but high specificity for detecting COVID-19 among asymptomatic individuals undergoing elective surgery. Objective diagnostic tests such as RT-PCR or Ag-RDT may still be needed to inform surgery schedules.

Resuming elective orthopaedic services during the COVID-19 pandemic : our experience.

AimsThe aim of this study was to surveil whether the standard operating procedure created for the NHS Golden Jubilee sufficiently managed COVID-19 risk to allow safe resumption of elective orthopaedic surgery.MethodsThis was a prospective study of all elective orthopaedic patients within an elective unit running a green pathway at a COVID-19 light site. Rates of preoperative and 30-day postoperative COVID-19 symptoms or infection were examined for a period of 40 weeks. The unit resumed elective orthopaedic services on 29 June 2020 at a reduced capacity for a limited number of day-case procedures with strict patient selection criteria, increasing to full service on 29 August 2020 with no patient selection criteria.ResultsA total of 2,373 cases were planned in the 40-week study period. Surgery was cancelled in 59 cases, six (10.2%) of which were due to having a positive preoperative COVID-19 screening test result. Of the remaining 2,314, 996 (43%) were male and 1,318 (57%) were female. The median age was 67 years (interquartile range 59.2 to 74.6). The median American Society of Anesthesiologists grade was 2. Hip and knee arthroplasties accounted for the majority of the operations (76%). Six patients tested positive for COVID-19 preoperatively (0.25%) and 39 patients were tested for COVID-19 within 30 days after discharge, with only five patients testing positive (0.22%).ConclusionThrough strict application of a COVID-19 green pathway, elective orthopaedic surgery could be safely delivered to a large number of patients with no selection criteria.Cite this article: Bone Jt Open 2021;2(11):951–957.

EP.WE.858Risk of Post-Operative COVID-19 Infection Following Breast Surgery

AimsTo study the risk of post-operative COVID-19 infection in patients undergoing breast surgery during the height of the pandemic in 2020.MethodsWe continued to perform surgery for breast cancers and other urgent breast conditions during the pandemic in a dedicated “Green” operating theatre in a COVID-19-free hospital. NHS guidance regarding staff and patient COVID-19 screening and patient self-isolation period changed frequently during the study period, and recommended guidance was followed. PPE was worn by theatre team. Patient records were subsequently reviewed for a positive COVID-19 swab or a COVID-19-related hospital admission within 8 weeks of surgery.Results96 consecutive operations were performed by 4 consultants between April and August 2020. All but 14 were for breast carcinoma. Median age 56 (21-89). Median ASA grade 2 (1-3). 64 patients had negative preoperative COVID-19 swabs, others in the early stages were screened with chest X-ray or CT. 83% (n = 80) were done as day cases. Among breast cancer operations there were 17 mastectomies, bilateral in 2 cases. There was no cases of COVID-19 positivity or COVID-19-related hospital admission post-operatively.ConclusionsBreast surgery, done mainly as day case, did not predispose patients to COVID-19 infection in the postoperative period when guidelines were followed. Concern about postoperative COVID-19 infection should not be a cause of surgical delay in any future waves, which can be potentially harmful to breast cancer patients.

SP4.2.11 Access to emergency theatre during the COVID -19 pandemic

AimsTo investigate the impact of the COVID‐19 pandemic on general surgical emergencies and access to theatre during the pandemic.MethodsWe retrospectively reviewed emergency theatre lists in three distinct time periods: October 2019 (pre-COVID-19 era), April 2020 (first peak) and October 2020 (regional second peak). We extracted and compared data from a prospectively maintained database to calculate patient waiting times. Statistical analysis was performed with SPSS software v21.0 to compare median waiting times between groups and significance was set to a p value of < 0.05.ResultsTable 1:Breakdown of waiting times per CEPOD category.October 2019April 2020October 2020P valuesNumber of procedures 15254105- Patient’s Median Waiting time (from surgical decision to theatre expressed in hours, minutes) 101:0201:0400:560.482A02:5603:4707:42<0.0142B13:2206:4010:27<0.049325:4921:0321:01 0.56Overall7:443:558:100.89Porter’s time overall (median)0:230:250:231Anesthetic time overall (median)0:240:290:220.88 Number of procedures delayed (more than expected when booked) 10/8 0/90/9 2A12/533/1715/35 2B16/852/236/55 31/60/50/6 Total29/1525/5421/105 ConclusionsDespite the initial major drop in general surgical procedures and waiting times, the decreased availability of theatre lists due to staff redeployment and sickness, the introduction of routine pre-operative COVID-19 testing have all resulted in a significant increase in waiting time for urgent (CEPOD 2A) cases during the second peak.

EP.WE.227YouTube as a source of patient information on elective surgery safety during the COVID-19 pandemic

AimsTo evaluate the understandability, actionability and quality of perioperative patient information conveyed by YouTube videos covering safety of elective surgery during the COVID-19 pandemic.MethodsYouTube search strategy was optimised using a combination of “COVID”, “safety”, and “surgery” terms. Each video was screened by two independent reviewers. The search was conducted on 9 January 2021. The understandability and actionability of videos were evaluated using validated Patient Education Materials Assessment Tool (PEMAT). Quality of perioperative patient information was determined with a novel 4-point checklist based on recommendations by the National Institute for Health and Care Excellence. The effect of video type on PEMAT and quality scores was assessed with Kruskal-Wallis Test. Scores were correlated with video metrics using Spearman's Rank.ResultsThe primary search revealed 594 videos. After deduplication and exclusions, 108 materials were analysed. Majority of videos (n = 89) originated from the USA, with only 4 produced in the UK. Hospital-produced videos had the highest understandability scores [median (IQR): 83.33% (18.40%)] and patient testimonies the lowest [55.91% (33.24%)] (p=0.002). Hospital materials were also most actionable [2.25 (2.40)], with news reports scoring lowest [0.0 (0.8)] (p=0.049). Social distancing, preoperative COVID-19 testing, and wearing face masks were mentioned in 46, 41, and 48 videos respectively. Only 9 materials recommended self-isolation before surgery. There was no significant correlation between video metrics (e.g., length) and scores.ConclusionsShort UK-specific videos should be created to outline accurate patient instructions for elective surgery during the COVID-19 pandemic and provide reassurance to help reduce the surgical backlog.

The safety of major gynaecologic cancer surgery without routine preoperative COVID-19 testing in the COVID-19 era: a multicentre, retrospective, case-control study

Our goal was to address the safety of major gynaecologic cancer surgery without routine preoperative COVID-19 testing in the COVID-19 era. The databases of seven gynaecologic cancer centres were searched in order to identify all consecutive gynaecologic cancer patients undergoing major surgery between March 11, 2020 and May 15, 2020 for this retrospective, case-control study. The case group consisted of patients with histopathologically confirmed gynaecologic cancers, and each case was matched with two counterparts who had undergone primary surgery before the COVID-19 pandemic. The case and the control groups were compared in terms of length of hospital stay, admission to the intensive care unit (ICU), intraoperative and postoperative complications. During the study period, 154 women with gynaecologic cancer undergoing major surgery were identified. Although the case group had more co-morbidities compared to the control group (103/154 vs. 178/308, respectively; p = .04), the median length of hospital stays, the rate of ICU admission, intraoperative complication rates and postoperative complication rates were similar in the two groups. Gynaecologic cancer surgery may be performed safely in the COVID-19 era with similar rates of ICU admission, intraoperative and postoperative complications compared to the patients operated before the COVID-19 pandemic. IMPACT STATEMENT What is already known on this subject? Many societies have announced their guidelines about the surgical management of gynaecologic cancer patients during the COVID-19 pandemic. However, most of them are not evidence-based and mostly on expert opinions. What do the results of this study add? The main findings of this retrospective, case-control study indicate that the short-term (30 day) outcomes of gynaecologic cancer patients undergoing major surgery in the COVID-19 era are similar to those who had been operated before the COVID-19 pandemic. The length of hospital stays, the rates of admission to the ICU, intraoperative and postoperative complications were comparable between women undergoing major gynaecologic cancer surgery in the COVID-19 era and the women who had been operated before the pandemic. What are the implications of these findings for clinical practice and/or further research? We can suggest that definitive surgery may be performed for gynaecologic cancer patients in the COVID-19 era if the resources permit and appropriate precautions such as social distancing, isolation and the use of personal protective equipment are taken.

1424 Enhanced Consent in Endocrine Surgery in The Era Of COVID-19

Abstract Aim Informed consent is the process by which surgeon and patient agree to undergo a procedure after the risk, benefits and alternative treatments have been discussed. The current COVID-19 pandemic provides unique challenges to the consent process such as the uncertain risk of acquiring the virus and the impact of a second peak on the health services. The aim of this audit was to use an enhanced consent tool to inform patients of specific risks associated with surgery during the pandemic. Method At the beginning of the pandemic, elective operating was postponed - these patients were added to a COVID-19 database. With the resumption of services, all patients had a telephone clinic appointment with a 2-fold aim: 1) to ensure they wanted to remain on the waiting list and 2) to discuss consent specifically with regard to COVID-19 using an enhanced consent tool. Results Over a 6-week period, 79 patients were contacted. All patients were awaiting thyroid, parathyroid and adrenal operations. Of the 79 patients contacted, 77 (97%) agreed to remain on the waiting list after discussing the risks using the enhanced consent tool. The remaining 2 patients asked for their operations to be delayed. To date, none of our patients have acquired COVID-19 upon the resumption of services. Conclusions Despite the uncertain risks of COVID-19, the majority of patients requiring endocrine surgery were happy to proceed. Ongoing review of available literature concerning preoperative risk and COVID-19 is essential for clinicians involved in the consent process. The use of an enhanced consent tool standardised the consent process and enabled patients to make an informed decision concerning their care.

741 Restarting Elective Orthopaedic Surgery During The COVID-19 Pandemic: Experiences and Patient Outcomes

Abstract Aim The COVID-19 pandemic resulted in postponing all non-urgent elective surgeries from April 2020. As we emerged from the first peak, restarting non-urgent services such as elective orthopaedic surgery was important for patients with chronic debilitating conditions. Our hospital successfully restarted orthopaedic surgery during the pandemic to help improve the quality of life of patients. This study describes the development of local protocols and pathways to allow for a safe restart of elective orthopaedic surgery in a COVID-19 free site. It presents the morbidity and mortality outcomes of those patients. Method This is a prospective cohort study evaluating all patients undergoing non-emergency orthopaedic procedures through a COVID-19 free pathway in a DGH from 18th May – 10th July 2020. 104 patients were identified, and their outcomes analysed during the 2 weeks following their surgery. Results No patients developed COVID-19 in the 2-weeks post-operative period. There were no ITU admissions or in-hospital deaths. 22(21.15%) out of 104 patients developed 23 complications within 2 weeks of surgery. These included: TIA, PE, AF, superficial wound infection, oozy wound and post-operative anaemia. They all made full recovery. There was no statistical difference in the development of complications for age (&amp;lt; 70; &amp;gt;70), gender, BMI, or ASA grades. Conclusions This study describes a roadmap to setting up a protocolised elective operating service for orthopaedic surgery. It has shown that standardised protocols in a COVID-19 free site, pre-operative COVID-19 testing and adherence to national guidelines on self-isolation prior to surgery can help prevent COVID-19 infection and its related risks post-operatively.

782 Evaluation of Ketamine Sedation as An Alternative to General Anaesthetic for The Management of Paediatric Soft Tissue Facial Injuries During the Covid-19 Pandemic

IntroductionStandard surgical practice of paediatric soft tissue facial injuries requires general anaesthetic (GA) if treatment with local anaesthetic is not tolerated. However, the Covid-19 pandemic has increased the risk of hospital admission for GA to patients and pre-operative Covid-19 testing can delay surgical treatment. In response, a service was established to facilitate short surgical procedures by the Oral and Maxillofacial surgical (OMFS) team with ketamine sedation (KS) at a tertiary level paediatric emergency department. Evaluation of this service demonstrates that KS is a suitable alternative to GA with reduced waiting times, low complications and equivalent surgical outcomes.Method20 patients treated under KS from May- September 2020 were identified and compared to a control group of 20 patients treated under GA during the same time period. Data including patient demographics, surgical treatment and the KS/GA procedure was collected from the medical records and was analysed using Microsoft excel.ResultsThe KS patients had shorter waits for treatment with 85% of patients waiting 1 day or less, compared with 55% for the GA group. Using the local KS protocol 1 or 2 doses of ketamine was sufficient in 79% of cases and adverse effects were minimal with 21% of KS patients suffering mild nausea and vomiting.ConclusionsKS is an acceptable alternative to GA for the management of paediatric soft tissue injuries. KS reduces inpatient admission for GA which is of increased importance during the Covid-19 pandemic. Other OMFS units would benefit from access to a similar service.

S1278 Asymptomatic Pediatric COVID-19 Positive Patients Captured Through Pre-operative Screening Program for Ambulatory Surgeries at a Tertiary Care Hospital

Introduction: Our hospital implemented universal pre-operative COVID-19 screening in April 2020 to reduce risk of transmission to caregivers as well to avert a potential anesthetic risk in COVID positive patients. The aim of this project was to determine the prevalence of asymptomatic COVID-19 infection among pediatric patients undergoing ambulatory procedures and surgeries, overall and for Pediatric Gastroenterology (GI) cases specifically. Methods: A retrospective chart review identified pediatric patients (≤21 years) who underwent ambulatory pre-operative COVID-19 testing between April 1, 2020-March 31, 2021. Demographic and health-related data was collected to identify asymptomatic COVID-19 positive patients scheduled for GI procedures and other ambulatory surgeries. We compared the proportion of patients who tested positive by age group, co-morbid condition, and surgical specialty. We also compared pediatric case rates to Ohio case rates. The study was IRB approved. Results: 4,663 asymptomatic pediatric patients underwent pre-operative COVID-19 testing by PCR and 81 patients were identified as positive (1.73%). In COVID-19 positive patients, 56% were male and 44% were female. Mean age was 12 years and patients 13-18 years were the age group with the highest fraction of positive tests (35%). 11% of patients screened were undergoing a GI-related procedure with a positivity rate of 1.3%. The peak in asymptomatic positives across all procedures occurred in November 2020 (30%), which preceded the peak in COVID-19 cases in Ohio by several weeks. Most prevalent co-morbid condition was asthma (15%) and 8% had inflammatory bowel disease. 5 patients were undergoing chemotherapy and none were on biologic therapy. 94% of cases were deferred. 25% of cases that proceeded required post-operative admission. Conclusion: Asymptomatic COVID-19 positive patients were identified before 1.73% of pediatric ambulatory procedures and before 1.3% of GI procedures. These case rates were higher than the concurrent adult case rate at our institution. The higher rate of asymptomatic COVID-19 infection in pre-operative pediatric ambulatory patients may reflect the milder disease in this age group. The peak in pediatric asymptomatic case positivity seemed to predict the subsequent peak case rate in the state of Ohio by a few weeks. As the pandemic continues with a large percentage of pediatric patients unvaccinated, pre-operative COVID-19 testing has important implications for pediatric GI and other ambulatory procedures.

P33.02 Day Case Thoracocoscopy With IPC Insertion

Northumbria Healthcare NHS Foundation Trust runs a large pleural service. Local anaesthetic medical thoracoscopy (LAT) is a well-established procedure in undiagnosed pleural effusions. Patients were traditionally admitted for a mean of 3.4 days and had a large bore drain inserted post LAT with pleurodesis. The Covid-19 pandemic has forced day case LAT provision with IPC placement without pleurodesis to minimise transmission risk. We describe our experience. LAT is performed in theatre under conscious sedation. All notes of patients requiring day case LAT between July 2020-Feb 2021 were analysed. Basic demographics and outcomes were collected. A descriptive analysis of the data was performed. 17 patients underwent day case LAT. All had negative pre-operative Covid-19 swabs: mean age 70.8 years (range 34-82), 12 male,5 female. Diagnoses included 5 lung cancers, 6 mesotheliomas and 4 fibrinous pleuritis. The lung did not deflate, not enabling biopsies in 2. Non-malignant diagnoses are currently presumed. 14 IPCs and 2 large bore drain were inserted due to 2 immediate complication (surgical emphysema). 1 patient developed an empyema within 30days. 9 out of the 11 IPCs have already been removed due to pleurodesis occurring (mean number days 60. All were discharged on the same day except the two requiring further drain insertion. We have thus transformed our service after more than a decade of providing LAT as an inpatient service. This is a small cohort of patients but proves the feasibility and safety of day case LAT with massive reduction in inpatient stay. The Covid-19 pandemic has transformed our service but for the better. Further qualitative work should elucidate the acceptability of such a pathway for patients.

Head and Neck Surgery During COVID-19 Pandemic: Experience from a Tertiary Care in India.

Head and neck pathologies requiring surgical intervention are considered a high-risk subsite in the context of COVID-19 pandemic by virtue of its close proximity to the mucosa of the upper aerodigestive tract. Retrospective review of all head and neck surgical procedures is undertaken during the pandemic from 23rd April 2020 to 30th September 2020. One hundred procedures were performed on 98 patients. COVID-19 status determined by SARS-Cov-2 RT-PCR at baseline was negative for 81, positive in 8 and unknown in 11. The RT-PCR negative subgroup included 40 diagnostic procedures and 41 ablative and or reconstructive procedures for head and neck neoplasms. None of the patients or health-care workers converted to COVID-19-positive status during the duration of the hospital stay. There were no cases with 30-day mortality. Clavien-Dindo grading for postoperative complications was as follows: 1–4, 2–12, 3a-2, 3b-1. Eleven patients with unknown COVID-19 status at baseline underwent emergency tracheostomy in a COVID-19 designated operating room for upper airway obstruction secondary to head and neck cancer. Of the 8 procedures conducted on known cases of COVID-19, 6 were tracheostomies performed for COVID-19 ARDS. The rest were maxillectomy for acute invasive mucormycosis and incision and drainage for parotid abscess. A matched-pair analysis was performed with similarly staged historical cohort operated during January to December 2016 to compare peri-operative complication rates (Clavien-Dindo Score). Incidence of complication with higher Clavien Dindo Score (>/=3a) was found to be lower in those patients operated during the pandemic (p=0.007). By meticulous preoperative COVID-19 screening and isolation, head and neck surgical procedures can be continued to avoid delay in diagnosis and treatment without jeopardising the risk of transmission of COVID-19 to the patients or health-care workers.

Preoperative COVID-19 Testing for Elective Ophthalmological Procedure in a Tertiary Health Care Centre: Our Experience During the Pandemic.

BackgroundTo study the prevalence of coronavirus infection among asymptomatic patients requiring eye surgery and the role of screening in prevention of spread of infection among the healthcare workers.DesignThe prospective observational study was conducted in the Ophthalmology department of a tertiary care center in Delhi from September 2020 to December 2020.SettingPatients requiring elective ophthalmological procedures in a tertiary care hospital were screened for coronavirus using the RT-PCR method. Testing methods and results were documented.ResultsAmong the 218 asymptomatic patients posted for elective surgery in that period, 16 (7.3%) were found to be positive for COVID-19. Those who tested positive were advised home isolation and surgery was postponed for the next 14 days. No complications were reported in these patients. One health-care worker also tested positive for COVID-19 during our study period.ConclusionIn our study, 1 out of 14 asymptomatic patients were found to be carriers for the novel virus. Asymptomatic COVID-infected patients may lead to transmission of the virus inside the hospital among the visiting patients and hospital staff while they have no adverse effect on the surgery and its outcome.

Surgical Outcomes in Benign Gynecologic Surgery Patients during the COVID-19 Pandemic (SOCOVID study)

Study ObjectiveTo determine the incidence of perioperative coronavirus disease (COVID-19) in women undergoing benign gynecologic surgery and to evaluate perioperative complication rates in patients with active, previous, or no previous severe acute respiratory syndrome coronavirus 2 infection.DesignA multicenter prospective cohort study.SettingTen institutions in the United States.PatientsPatients aged >18 years who underwent benign gynecologic surgery from July 1, 2020, to December 31, 2020, were included. All patients were followed up from the time of surgery to 10 weeks postoperatively. Those with intrauterine pregnancy or known gynecologic malignancy were excluded.InterventionsBenign gynecologic surgery.Measurements and Main ResultsThe primary outcome was the incidence of perioperative COVID-19 infections, which was stratified as (1) previous COVID-19 infection, (2) preoperative COVID-19 infection, and (3) postoperative COVID-19 infection. Secondary outcomes included adverse events and mortality after surgery and predictors for postoperative COVID-19 infection. If surgery was delayed because of the COVID-19 pandemic, the reason for postponement and any subsequent adverse event was recorded. Of 3423 patients included for final analysis, 189 (5.5%) postponed their gynecologic surgery during the pandemic. Forty-three patients (1.3% of total cases) had a history of COVID-19. The majority (182, 96.3%) had no sequelae attributed to surgical postponement. After hospital discharge to 10 weeks postoperatively, 39 patients (1.1%) became infected with severe acute respiratory syndrome coronavirus 2. The mean duration of time between hospital discharge and the follow-up positive COVID-19 test was 22.1 ± 12.3 days (range, 4–50 days). Eleven (31.4% of postoperative COVID-19 infections, 0.3% of total cases) of the newly diagnosed COVID-19 infections occurred within 14 days of hospital discharge. On multivariable logistic regression, living in the Southwest (adjusted odds ratio, 6.8) and single-unit increase in age-adjusted Charlson comorbidity index (adjusted odds ratio, 1.2) increased the odds of postoperative COVID-19 infection. Perioperative complications were not significantly higher in patients with a history of positive COVID-19 than those without a history of COVID-19, although the mean duration of time between previous COVID-19 diagnosis and surgery was 97 days (14 weeks).ConclusionIn this large multicenter prospective cohort study of benign gynecologic surgeries, only 1.1% of patients developed a postoperative COVID-19 infection, with 0.3% of infection in the immediate 14 days after surgery. The incidence of postoperative complications was not different in those with and without previous COVID-19 infections.

Gynecologic Surgery during the COVID-19 Pandemic: Is Universal Screening Mandatory?

This study is aimed at evaluating the results of the universal preoperative screening for COVID-19 in gynecologic cases operated on during its outbreak in a tertiary care hospital in Bangkok, Thailand. A retrospective descriptive study was done on all patients who underwent elective or emergency gynecologic surgeries during the pandemic period in Thailand (April 15 to June 5, 2020). The COVID-19 screening results by symptom-based screening, risk-based screening, and RT-PCR for COVID-19 were collected from the electronic medical records. Among 129 patients who underwent gynecologic surgeries, none had a positive RT-PCR for COVID-19. Symptom-based screening found no patients with positive symptoms for COVID-19. Risk-based screening found 4 patients (3.1%) who were in contact with suspected or confirmed COVID-19 cases and 4 patients (3.1%) who were healthcare personnel. In conclusion, routine preoperative RT-PCR for COVID-19 may need to be reconsidered among asymptomatic individuals in a low-prevalence country during the well-controlled COVID-19 situation. Larger studies are required to ascertain the benefit of universal preoperative COVID-19 testing.

Safety of elective paediatric surgery during the coronavirus disease 2019 pandemic

IntroductionCorona-virus Disease 2019 (COVID-19) has had a huge impact on the delivery of healthcare worldwide, particularly elective surgery. There is a lack of data regarding risk of postoperative COVID-19 infection in children undergoing elective surgery, and regarding the utility of pre-operative COVID-19 testing, and preoperative “cocooning” or restriction of movements. The purpose of this present study was to examine the safety of elective paediatric Otolaryngology surgery during the COVID-19 pandemic with respect to incidence of postoperative symptomatic COVID-19 infection or major respiratory complications. Materials and methodsProspective cohort study of paediatric patients undergoing elective Otolaryngology surgery between September and December 2020. Primary outcome measure was incidence of symptomatic COVID-19 or major respiratory complications within the 14 days after surgery. Parents of prospectively enrolled patients were contacted 14 days after surgery and enquiry made regarding development of postoperative symptoms, COVID-19 testing, or diagnosis of COVID-19. Results302 patients were recruited. 125 (41.4%) underwent preoperative COVID-19 RT-PCR testing. 66 (21.8%) restricted movements prior to surgery. The peak 14-day COVID-19 incidence during the study was 302.9 cases per 100,000 population. No COVID-19 infections or major respiratory complications were reported in the 14 day follow-up period. ConclusionThe results of our study support the safety of elective paediatric Otolaryngology surgery during the pandemic, in the setting of community incidence not exceeding that observed during the study period.

Safe Elective Surgical Practice During COVID-19 Pandemic - A Prospective Observational Study of 303 Elective Surgeries in the UK.

AimDuring the COVID-19 pandemic, there has been worldwide cancellation of elective surgeries to protect patients from nosocomial viral transmission and peri-operative complications. With the unfolding situation, there is a definite need for an exit strategy to reinstate elective services. Therefore, more literature evidence supporting exit plans for elective surgical services is imperative to adopt a safe working principle. This study aims to provide evidence for safe elective surgical practice during the pandemic.MethodologyThis single centre, prospective, observational study included adult patients who were admitted and underwent elective surgical procedures in the trust’s COVID-free environment at the Birmingham Treatment Centre between May 19 and July 14, 2020. Data were collected on demographic parameters, peri-operative variables, surgical specialities, COVID-19 reverse transcription polymerase chain reaction (RT-PCR) testing results, post-operative complications and mortality. The study also highlighted the protocols it followed for the elective services during the pandemic.ResultsA total of 303 patients were included with mean age of 49.9 years (SD 16.5) comprising of 59% (178) female and 41% (125) male. They were classified according to the American Society of Anaesthesiologist Grade, different surgical specialities and types of anaesthesia used. Ninety-six percent (96%) of patients were discharged on the same day. Hundred percent (100%) compliance with pre-operative COVID-19 RT-PCR testing was maintained. There was no 30-day mortality or major respiratory complications.ConclusionCareful patient selection, simultaneous involvement of the pre-assessment and anaesthetic team, strict adherence to peri-operative protocols and delivering vigilant post-operative care for COVID-19 infection can help provide safe elective surgical services if the community transmission is under reasonable control. However, it is particularly important to maintain COVID-free safe environment for such procedures.

Patient Perception Regarding the Safety of Elective Joint Arthroplasty Surgery During the COVID-19 Pandemic.

BackgroundTotal joint arthroplasty (TJA) practices have been dramatically impacted by the COVID-19 pandemic. To date, no study has assessed trends in patient perceptions regarding the safety of elective TJA.MethodsA single-institution, prospective cohort study was conducted between May 11th and August 10th, 2020. All patients who underwent elective hip and knee arthroplasty were contacted via telephone or emailed surveys. Two-hundred and thirty-five consecutive patients were screened, and 158 agreed to participate. The average age was 65.9 ± 11.5 years, with 51.0% of patients being female. The percentage of participants who underwent total knee, total hip, and unicompartmental knee arthroplasty was 41.4%, 37.6%, and 21.0%, respectively. Survey components assessed demographic data, level of concern and specific concerns about the pandemic, and factors increasing patient comfort in proceeding with surgery.ResultsOlder age (P = .029) and female sex (P = .004) independently predicted higher concern on multivariate analysis. Race (P = .343), surgical site (knee vs hip, P = .58), and procedure type (primary vs revision, P = .26) were not significantly related to degree of concern. Most participants (71.5%) disagreed that the pandemic would negatively affect the outcome of their surgery. Patient concern mirrored statewide COVID-19 cases and deaths, rather than local municipal trends. The most cited reassuring factors were preoperative COVID-19 testing, personal protective equipment usage by hospital staff, and surgeon support.ConclusionsPatient concern regarding the safety of elective TJA may follow broader policy-level events rather than local trends. Surgeons should note that universal preoperative COVID-19 testing, adequate personal protective equipment, and surgeon support were reassuring to patients.Level of EvidenceLevel IV Therapeutic.

Preoperative COVID-19 Testing in a Pediatric Ambulatory Setting: Lessons Learned

Background InformationPerianesthesia nurses have a unique set of knowledge and skills, which allows them to quickly adapt and continuously improve processes to meet the perioperative needs of their patients. The recent global SARS-CoV-2 pandemic required many perianesthesia nurses to support the screening of surgical patients by performing Polymerase Chain Reaction (PCR) tests preoperatively. Testing pediatric patients presents unique challenges that require constant assessment of processes that work well and the application of interventions to address barriers to success.ObjectiveThe development and implementation of a drive-thru COVID-19 preoperative testing site in a pediatric ambulatory setting.Process of ImplementationA core group of perianesthesia nurses developed a drive-thru testing site for pediatric patients scheduled for surgery. All pediatric patients require PCR testing within 24-48 hours preoperatively. Obtaining oropharyngeal (OP), nasopharyngeal (NP), or anterior nares (AN) swab can be challenging in the pediatric population. Numerous techniques were found to help support successful testing such as social stories, involving child life specialists, and distraction techniques (bubbles, music). Nurses use of pretend play, small incentives, and comfort holds provided additional reassurance. Verbal and written testing instructions have been continuously revised to include reminders to wear a mask, limit exposure, and how to provide care at home if a test result is positive.State of Successful PracticeThe preoperative COVID-19 testing site initially allowed for testing of a small number of patients requiring time-sensitive surgery during the height of the pandemic. We have since vastly increased our caseload and currently support testing of up to 70 patients daily. In a 6-month span, there have only been four patients who were unable to successfully complete their preoperative SARS-CoV-2 PCR test.Implications for Advancing the Practice of Perianesthesia NursingAs the global health pandemic continues it is imperative to utilize best practices for preoperative COVID-19 testing. Continuously reevaluating and implementing safe and effective testing techniques reduces the risk of transmission and supports quality care. Sharing ideas, lessons learned, and best practices of how nurses have implemented new perioperative processes is essential for advancing the practice of perianesthesia nursing during a global pandemic.

Provider attitudes and satisfaction with rapid preoperative point-of-care COVID-19 testing using IDNOW™.

PurposeHealthcare workers have experienced high levels of anxiety during the COVID-19 pandemic, particularly when caring for patients with unknown infection status. We trialled rapid preoperative point-of-care COVID-19 testing using the Abbott ID NOW™ COVID-19 for clinical validation in an urgent surgical population at a single centre in British Columbia, Canada. Here, we sought to determine the opinions and beliefs of operating room (OR) staff on the usefulness and effectiveness of point-of-care tests on workflow and wellbeing in the OR.MethodsThis descriptive study used a mixed-methods cross-sectional survey of all OR staff (nurses, anesthesiologists, surgeons, and ancillary staff) at a single centre after using the ID NOW for three months. Outcomes of interest included healthcare worker satisfaction with the ID NOW, effects on OR workflow, and worries about COVID-19 transmission.ResultsThe overall response rate was 56% (n = 133), and was highest among anesthesiologists (100%, n = 38). Respondents were satisfied with the performance of the ID NOW for rapid COVID-19 testing in preoperative patients, giving it a mean (standard deviation [SD]) rate of 4.4 [1.4] on a five-point scale. Most (115/128, 90%) recommended continued use of the ID NOW on asymptomatic patients while there are active cases of COVID-19 in the community. Respondents felt that preoperative COVID-19 testing with the ID NOW made the OR safer for staff (mean [SD] rate, 4.2 [0.8]) and patients (mean [SD] rate, 4.0 [0.9]).ConclusionDuring the COVID-19 pandemic, it is important to maintain the physical and mental wellbeing of hospital staff. Rapid point-of-care testing increased the sense of workplace safety, improved morale, and reduced worry associated with COVID-19 without excessive disruption of OR workflow.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12630-021-02073-4.