Andrew P. Katz MD1, Francisco J. Civantos MD FACS1, Zoukaa Sargi MD MPH1, Jason M. Leibowitz MD FACS1, Elizabeth Nicolli MD FACS1, Donald Weed MD FACS1, Alexander E. Moskovitz BA1, Alyssa M. Civantos BA2, David M. Andrews MD1, Octavio Martinez MD1, Giovana R. Thomas MD FACS1
 
1Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL
2Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
 
Address correspondence and reprint request to:
Francisco J. Civantos MD FACS
Sylvester Medical Office Building
1121 NW 14 St Rm 320
Miami, FL 33136
Phone: (305) 243-5276, E-mail: fcivanto@med.miami.edu
 
Brief Running Title: False positive preoperative COVID-19 tests
Keywords: COVID-19, pandemic, head and neck surgery, RT-PCR, preoperative testing
Funding and conflicts of interests: None
Acknowledgements: The authors would like to acknowledge Alejandro Mantero PhD for assistance with statistical review.
ABSTRACT
 Background: There are no reports regarding false positive reverse transcriptase polymerase chain reaction (RT-PCR) for novel coronavirus in preoperative screening.
 
Methods: Pre-operative patients had one or two nasopharyngeal swabs, depending on low or high risk of viral transmission. Positive tests were repeated.
 
Results: Forty-three of 52 patients required 2 or more pre-operative tests. Four (9.3%) had discrepant results (positive/negative). One of these left the COVID unit against medical advice despite an orbital abscess, with unknown true disease status. The remaining 3 of 42 (7.1%) had negative repeat RT-PCR. Although ultimately considered false positives, one had been sent to a COVID-unit postoperatively, and two had urgent surgery delayed. Assuming negative repeat RT-PCR, clear chest imaging, and lack of subsequent symptoms represent the "gold standard”, RT-PCR specificity was 0.97.
 
Conclusions: If a false positive is suspected, we recommend chest computed tomography and repeat RT-PCR. Validated immunoglobulin testing may ultimately prove useful.