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

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.