METHODS
All surgical cases scheduled at our medical campus between March 30,
2020 and April 24, 2020 were reviewed. Before surgery, these cases had
been presented to and approved by a Surgical Review Committee and were
deemed either emergent or urgent. Departmental policy regarding
preoperative screening evolved over this time period but solidified by
the second week of this study (for detailed explanation of policies,
refer to Civantos et al.6). For procedures involving
mucosa of the upper respiratory tract, which pose high-risk for
aerosolization of virus if present, two negative tests were required
preoperatively with the second test recommended within 24 hours of
surgery. For surgeries not involving mucosa (i.e., low risk), only one
negative preoperative test was required.
Patients were tested preoperatively for SARS-CoV-2 infection on
nasopharyngeal swabs using RT-PCR with at least one RNA primer approved
by the Food and Drug Administration for testing. At the beginning of the
study period, tests were outsourced to LabCorp (Burlington, NC) and
Quest Diagnostics (Secaucus, NJ) laboratories, with turnaround time of
five to seven days. As time progressed, the process was effectively
streamlined by hospital administration, laboratory administration and
personnel, and the preoperative department. RT-PCR was transitioned to
testing in our own hospitals, with turnaround time of four hours or
less. The in-house test systems and molecular targets can be found in
Table 1. Multiple platforms were kept available due to supply chain
shortages with all systems during the pandemic. Obtaining testing
cartridges, kits, and reagents were a challenge in South Florida from
mid-March until early May. Thus, in order to ensure that our ability to
run RT-PCR for SARS-CoV-2 was not interrupted, several platforms were
kept available at all times.
Patients with discrepant results were those who had different results on
the first two preoperative tests (i.e., one positive and one negative).
All patients were closely followed perioperatively by their surgeons and
members of the committee to ensure the safety of the patient and all
healthcare personnel involved.
Data was analyzed using univariate analyses: percentages were used to
summarize categorical outcomes and sensitivity was calculated to
determine test performance. The study was granted exemption by the
University of Miami Institutional Review Board.