COVID-19 Risk in Elective Surgery during a Second Wave: a Prospective Cohort Study.

Abstract

The COVID-19 pandemic has greatly affected access to elective surgery, largely because of concerns for patients and healthcare workers. A return to normal surgery workflow depends prevalence and transmission of coronavirus in elective surgical patients. The aim of this study was to determine the prevalence of active SARS-CoV-2 infection during a second wave among patients admitted to hospital for elective surgery in Victoria. Prospective cohort study across 8 hospitals in Victoria during July-August 2020, enrolling adults and children admitted to hospital for elective surgery or interventional procedure requiring general anaesthesia. Study outcomes included a positive PCR test for SARS-CoV-2 in the preoperative period (primary outcome); and for those with a negative test preoperatively, the incidence of a positive PCR test for SARS-CoV-2 in the postoperative period. We enrolled 4,965 elective adult and paediatric surgical patients from 15 July to 31 August, 2020. Four patients screened negative on questionnaire but had a positive PCR test for coronavirus, resulting in a Bayesian estimated prevalence of 0.12% (95% probability interval: 0 to 0.26%). There were no reports of healthcare worker infections linked to elective surgery during and up to 2 weeks after the study period. The prevalence of SARS-CoV-2 in asymptomatic elective surgical patients during a second wave was approximately 1 in 833. Given the very low likelihood of coronavirus transmission, and with existing current hospital capacity, recommencement of elective surgery should be considered. A coronavirus screening checklist should be mandated for surgical patients.