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Preoperative nasopharyngeal swab testing and postoperative pulmonary
complications in patients undergoing elective surgery during the SARS-CoV-2
pandemic
#MMPMID33640908
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Br J Surg
2021[Jan]; 108
(1
): 88-96
PMID33640908
show ga
BACKGROUND: Surgical services are preparing to scale up in areas affected by
COVID-19. This study aimed to evaluate the association between preoperative
SARS-CoV-2 testing and postoperative pulmonary complications in patients
undergoing elective cancer surgery. METHODS: This international cohort study
included adult patients undergoing elective surgery for cancer in areas affected
by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection
before operation were excluded. The primary outcome measure was postoperative
pulmonary complications at 30 days after surgery. Preoperative testing strategies
were adjusted for confounding using mixed-effects models. RESULTS: Of 8784
patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent
preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT
only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9
per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk
adjustment, having at least one negative preoperative nasopharyngeal swab test
(adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98;
P?=?0.040) was associated with a lower rate of pulmonary complications. Swab
testing was beneficial before major surgery and in areas with a high 14-day
SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk
areas. To prevent one pulmonary complication, the number needed to swab test
before major or minor surgery was 18 and 48 respectively in high-risk areas, and
73 and 387 in low-risk areas. CONCLUSION: Preoperative nasopharyngeal swab
testing was beneficial before major surgery and in high SARS-CoV-2 risk areas.
There was no proven benefit of swab testing before minor surgery in low-risk
areas.
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