INTRODUCTION
The World Health Organization designated the COVID-19 Coronavirus
Disease outbreak as a global pandemic on March 11,
2020.1 Three days later the Surgeon General
recommended that all elective surgeries be cancelled, and on March 20,
2020, elective surgeries were banned in the state of
Florida.2,3 The rapid and deadly spread of this
pandemic has led to a reconsideration of traditional treatment paradigms
in head and neck surgery, with an emphasis on protecting both the
patient as well as the treatment team.4,5,6 The virus
responsible for COVID-19, SARS-CoV-2, poses a particular risk to
providers involved in the care of otolaryngology patients due to
examinations and surgeries involving the nasopharynx, oropharynx, and
upper aerodigestive tract, which harbor high concentrations of viral
particles. Instrumentation of these areas may aerosolize viral
particles, further increasing the risk of infection for any member of
the surgical team.7,8
In an effort to ensure the safety of both patients and providers
requiring urgent otolaryngology surgeries, the University of Miami has
adopted protocols in order to triage patients prior to head and neck
surgeries.6 In line with other institutions across the
globe, these protocols call for preoperative testing of asymptomatic
patients using reverse transcriptase polymerase chain reaction (RT-PCR)
given reports of asymptomatic carriers of SARS-CoV-2 capable of
transmission.9-16 Reports of the sensitivity of the
RT-PCR are limited, and the studies have relatively small sample sizes;
however, sensitivity is reported between 63% and
78%.17-19 Few papers report the specificity, but
specificity has been cited as high as 98.8%.17Sensitivity changes depending on the site of collection, with
oropharyngeal swabs lower than nasopharyngeal swabs, but sputum and
bronchoalveolar lavage with sensitivity reported as high as 72% and
93%, respectively.19 Importantly, these numbers may
differ between and even within institutions due to the wide variety of
testing platforms that have different molecular targets for the virus
particle. It remains unclear how sensitive and specific RT-PCR tests are
for detecting SARS-CoV-2 in asymptomatic patients in the preoperative
setting.
In this article, we discuss the importance of considering the potential
for false positive results when testing these patients. False positive
tests carry serious implications for preoperative patients and providers
and can lead to changes in patient care that would not otherwise have
occurred. Our objective is to share our experiences with false positive
test results during preoperative screening, discuss the implications for
our patients, and offer our recommendations regarding these
circumstances.