Proper screening procedures led to no reports of COVID-19 after orthopedic surgery
Published results showed pre-surgical testing and proper screening procedures led to no reports of the development of any symptoms related to COVID-19 or a positive test postoperatively among patients who underwent orthopedic surgery.
Nikhil N. Verma, MD, and colleagues asked 1,119 patients scheduled for elective orthopedic sports medicine procedures at one of two outpatient surgical centers between July 1, 2020, and Dec. 31, 2020, to complete a custom survey that assessed for any COVID-19-related symptoms during a postoperative clinic visit or phone call at a minimum of 2 weeks or complete a routine screening questionnaire and temperature screen at the time of the first postoperative follow-up visit. Both surgery centers instituted standard COVID-19 precautions, that included the need for a negative preoperative COVID-19 polymerase chain reaction test, symptoms screening and temperature check, restricted visitor policy, mask wearing of all staff and patients, strict handwashing and social distancing protocols where possible, according to researchers. Researchers reviewed surgical case logs for any canceled surgeries due to a positive preoperative COVID-19 test.
Results showed 3.5% of patients had their surgery canceled due to diagnosis of COVID-19 during preoperative testing. Researchers found patients with a positive preoperative COVID-19 test were significantly younger compared with patients with a negative test. At a minimum of 2 weeks postoperatively, no patients were diagnosed with COVID-19 or reported symptoms concerning for COVID infection, according to results. Researchers also found no patients underwent additional testing or reported close contact with another individual with a positive test or possessed symptoms concerning for COVID-19.
“Using a combination of pre-surgical testing, along with proper screening procedures and universal precautions, elective surgery can be safely performed even in times of increasing community prevalence of COVID-19,” Verma told Healio Orthopedics. “This is impactful because delays in elective surgeries have direct physical, emotional, social and economic effects on patients. The ability to perform elective surgeries safely even during pandemic conditions has a direct positive impact on patient care.”
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Harsh Singh, BA, and colleagues at Rush University Medical reported that no patients having elective outpatient orthopedic surgery performed in an ASC using preoperative screening protocols during the coronavirus pandemic developed COVID-19. A total of 3.5% of patients (n=39/1119) scheduled for surgery were diagnosed with COVID-19 during preoperative testing, resulting in surgical cancellation. They concluded that elective outpatient orthopedic surgery performed in an ASC is safe with no documented cases of COVID-19 transmission in their cohort.
Obviously, during the pandemic, the overarching concern of a health care system and community was to mitigate the spread of the pathogen and ensure patient and staff safety. Even though these were elective surgeries, many needed to be done for patient function, decreased pain and ability to return to work and recreational activity. The success to find COVID-19-positive patients prior to surgery to prevent spread among patients, staff and physicians, and the fact that no patients developed COVID-19 during the 2 weeks after their surgery is proof that the testing and screening protocols in place were successful.
In our health system, our pre-procedural COVID-19 test positivity rate correlated with what was going on in our community. Our highest positivity rates for all procedures, not just elective, correlated with student return to campus in August (1.42%), after the Thanksgiving holiday (1.81%) and early January after the return from Christmas or winter break (2.5%). Despite this, at all times, our positivity rate was lower than community spread. This patient population was younger and probably healthier than the population most affected by COVID-19, so the small risk associated with elective surgery was worth it to these patients and the physician. When all of us come together to work for a common goal, we can be safe and successfully and provide excellent medical care even in a pandemic.
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