Mawhorter Michael E, Nguyen Paul, Goldsmith Mackenzie, Owens Russell Grant, Baer Blake, Raman Jay D
Department of Urology, Penn State Health Milton S. Hershey Medical Center Hershey, PA, USA.
Department of Urology, University of Iowa Iowa, IA, USA.
Am J Clin Exp Urol. 2022 Oct 15;10(5):341-344. eCollection 2022.
Infection with COVID-19 presents known and unknown perioperative risks to the patient and operative staff. Pre-operative testing protocols have become widespread, yet little is known about the utility of this practice in asymptomatic patients undergoing elective surgery. We describe the impact and cost of a routine testing protocol on elective surgical procedures in a retrospective series at a single institution.
Standardized pre-operative COVID-19 testing in all surgical patients was implemented in May 2020. Health system protocol required testing 3 to 5 days before all elective surgery. Data stratified by surgical specialty were collected over the initial 90-day period and disposition over a period of 6-months was assessed for all positive and indeterminate results.
Thirty-one (0.41%) positive results amongst 7579 pre-procedural tests, including 3 of 792 (0.38%) for urologic procedures, were noted in asymptomatic patients. Following a positive test, 20 procedures (62.5%) were delayed an average of 49 days, 8 were not performed and 3 proceeded without delay. All 3 urologic procedures were delayed a mean of 59 days. Institutional cost per test ranged from $34-$54. The number needed to test for one positive result was 244 with a cost of $11,573 for each positive result.
Institution of a universal pre-operative COVID-19 screening protocol for asymptomatic, unvaccinated patients undergoing elective surgery identified clinically silent infection in 0.4% of cases with a significant associated cost. Risk and symptom-based testing is likely a better strategy for triaging resources.
感染新型冠状病毒肺炎会给患者和手术人员带来已知和未知的围手术期风险。术前检测方案已广泛应用，但对于该做法在接受择期手术的无症状患者中的效用知之甚少。我们在一家机构的回顾性系列研究中描述了常规检测方案对择期手术的影响和成本。
2020年5月对所有手术患者实施标准化的术前新型冠状病毒肺炎检测。卫生系统方案要求在所有择期手术前3至5天进行检测。在最初的90天内收集按手术专科分层的数据，并对所有阳性和不确定结果在6个月内的处理情况进行评估。
在7579例术前检测中，有31例（0.41%）呈阳性结果，其中包括792例泌尿外科手术中的3例（0.38%），这些均为无症状患者。检测呈阳性后，20例手术（62.5%）平均推迟了49天，8例未进行，3例未延迟进行。所有3例泌尿外科手术平均推迟了59天。每次检测的机构成本在34美元至54美元之间。检测出一例阳性结果所需的检测数量为244次，每次阳性结果的成本为11,573美元。
对接受择期手术的无症状、未接种疫苗的患者实施通用的术前新型冠状病毒肺炎筛查方案，在0.4%的病例中发现了临床无症状感染，且成本高昂。基于风险和症状的检测可能是更好的资源分类策略。
