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.