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.