Pre-surgical Screening for SARS-CoV-2 Testing in Elective Procedures in High Burden Resource Limited Settings: A Retrospective Observational Study

Swathi Suravaram, Imran Ahmed Siddiqui, Shazia Naaz, Vivek Hada, Mahamad Wajid, Prasanth Gurijala, Padala Chaitanya Goud, Srinivas Maddur
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Abstract

Introduction: Pre-surgical screening of patients for COVID-19 by Reverse transcription-Polymerase Chain Reaction (RT-PCR) is essential before surgeries as a precautionary measure in view of preventing COVID-19 to the health care workers. The inception of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS- COV-2) posed major hurdles and challenges in conducting elective surgeries. Considering that COVID-19 is expected to continue to be a problem for the public health system in the near future, institutions will need to create risk mitigation strategies with meticulous resource management especially in high burden centers. Aim: To assess the role and need of repeat RT-PCR testing after an initial negative at a tertiary care center in view of the ever changing dynamics of COVID-19. Materials and Methods: A retrospective observational study was conducted at the Mobile Virology Research & Diagnostic Laboratory in the Department of Microbiology, ESIC Medical College & Hospital, Hyderabad between September 2020 to May 2021. Pre- surgical cases admitted at the facility during the study period with ≥72 h duration of stay who have been tested for SARS-COV-2 RT-PCR more than once within a period of one week were included. RT-PCR testing was performed according to standard protocols. Clinical and demographic data were collected, including reasons for re-testing. Results: A total of 2398 patients were admitted for surgeries during the study period, out of which 697 cases had a prolonged stay ≥72 h. In all of the cases, the initial test was negative, but 11 (1.58%) of them converted to positive. During the zenith of the second wave, the conversion rate was 4%, whereas it was only 0.2% during non peak periods. Conclusion: Hence, it was concluded that to optimise the usefulness of pre-surgical screening test for SARS-COV-2, repeat testing may be avoided in a low burden setting with timely reassessment based on local positivity rate. Each facility should continuously reassess their needs based on sudden local surges to optimise utilisation, especially when faced with resource constraints and changing paradigm of the pandemic.
高负担资源有限地区选择性手术中SARS-CoV-2检测的术前筛查:一项回顾性观察研究
导语:术前应用逆转录聚合酶链反应(RT-PCR)筛查患者COVID-19是医护人员预防COVID-19的必要预防措施。严重急性呼吸系统综合征冠状病毒-2 (SARS- COV-2)的出现给择期手术的开展带来了重大障碍和挑战。考虑到COVID-19预计将在不久的将来继续成为公共卫生系统的问题,各机构需要制定风险缓解战略,并进行细致的资源管理,特别是在高负担中心。目的:考虑到COVID-19不断变化的动态,评估三级医疗中心首次阴性后重复RT-PCR检测的作用和必要性。材料和方法:在移动病毒学研究中心进行了一项回顾性观察研究。ESIC医学院微生物系诊断实验室;2020年9月至2021年5月期间,海德拉巴医院。纳入研究期间住院时间≥72小时且在一周内进行过一次以上SARS-COV-2 RT-PCR检测的手术前病例。按照标准方案进行RT-PCR检测。收集临床和人口统计数据,包括重新检测的原因。结果:研究期间共收治2398例手术患者,其中697例住院时间≥72 h。所有患者初检阴性,其中11例(1.58%)转为阳性。在第二波浪潮的顶峰时期,转化率为4%,而在非高峰时期,转化率仅为0.2%。结论:为优化术前SARS-COV-2筛查试验的有效性,可在低负担环境下避免重复检测,并根据局部阳性率及时重新评估。每个设施都应根据当地突然激增的情况,不断重新评估其需求,以优化利用,特别是在面临资源限制和大流行病范例不断变化的情况下。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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