Preoperative Testing

The issue of preoperative SARS-CoV-2 testing remains a controversial topic. Given the aerosolizing nature of major head and neck surgery, risk of transmission to health care providers from asymptomatic patients is a major concern. Additionally, there is legitimate concern that operating on a patient in the preclinical incubation period may lead to worse outcomes with postoperative respiratory compromise4.
At the University of Pittsburgh, preoperative testing has recently become available to all of our patients undergoing major head and neck surgery. We are now making this an essential component of the preoperative evaluation. Patients that test positive will be postponed and those that test negative will proceed with surgery. However, given that our institutional PCR based testing has a quoted false negative rate of nearly 25%, procedures on negative patients will still be performed with full PPE and N95 masks. It should be noted that some institutions are requiring two negative preoperative tests prior to proceeding with surgery. We have not yet adopted this strategy. Postoperatively, standard surgical masks are worn by the care team during non-aerosolizing care.