Low prevalence (0.13%) of COVID-19 infection in asymptomatic pre-operative/pre-procedure patients at a large, academic medical center informs approaches to perioperative care

Affiliations

¹ Department of Urology/Department of Information Services and Solutions, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Medical Center, CA. Electronic address: jsinger@mednet.ucla.edu.
² Department of Neurology/Department of Information Services and Solutions, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Medical Center, CA.
³ Department of Medicine/Department of Information Services and Solutions, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Medical Center, CA.
⁴ Department of Pediatrics, Division of Pediatric Infectious Diseases, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Medical Center, CA.
⁵ Department of Surgery, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Medical Center, CA.
⁶ Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Medical Center, CA.
⁷ Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Medical Center, CA.
⁸ Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Medical Center, CA.
⁹ Department of Orthopedic Surgery/Department of Information Services and Solutions, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Medical Center, CA.

PMID: 33008615
PMCID: PMC7427530
DOI: 10.1016/j.surg.2020.07.048

Observational Study

Low prevalence (0.13%) of COVID-19 infection in asymptomatic pre-operative/pre-procedure patients at a large, academic medical center informs approaches to perioperative care

Jennifer S Singer et al. Surgery. 2020 Dec.

. 2020 Dec;168(6):980-986.

doi: 10.1016/j.surg.2020.07.048. Epub 2020 Aug 14.

Authors

Affiliations

¹ Department of Urology/Department of Information Services and Solutions, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Medical Center, CA. Electronic address: jsinger@mednet.ucla.edu.
² Department of Neurology/Department of Information Services and Solutions, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Medical Center, CA.
³ Department of Medicine/Department of Information Services and Solutions, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Medical Center, CA.
⁴ Department of Pediatrics, Division of Pediatric Infectious Diseases, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Medical Center, CA.
⁵ Department of Surgery, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Medical Center, CA.
⁶ Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Medical Center, CA.
⁷ Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Medical Center, CA.
⁸ Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Medical Center, CA.
⁹ Department of Orthopedic Surgery/Department of Information Services and Solutions, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Medical Center, CA.

PMID: 33008615
PMCID: PMC7427530
DOI: 10.1016/j.surg.2020.07.048

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has resulted in reduced performance of elective surgeries and procedures at medical centers across the United States. Awareness of the prevalence of asymptomatic disease is critical for guiding safe approaches to operative/procedural services. As COVID-19 polymerase chain reaction (PCR) testing has been limited largely to symptomatic patients, health care workers, or to those in communal care centers, data regarding asymptomatic viral disease carriage are limited.

Methods: In this retrospective observational case series evaluating UCLA Health patients enrolled in pre-operative/pre-procedure protocol COVID-19 reverse transcriptase (RT)-PCR testing between April 7, 2020 and May 21, 2020, we determine the prevalence of COVID-19 infection in asymptomatic patients scheduled for surgeries and procedures.

Results: Primary outcomes include the prevalence of COVID-19 infection in this asymptomatic population. Secondary data analysis includes overall population testing results and population demographics. Eighteen of 4,751 (0.38%) patients scheduled for upcoming surgeries and high-risk procedures had abnormal (positive/inconclusive) COVID-19 RT-PCR testing results. Six of 18 patients were confirmed asymptomatic and had positive test results. Four of 18 were confirmed asymptomtic and had inconclusive results. Eight of 18 had positive results in the setting of recent symptoms or known COVID-19 infection. The prevalence of asymptomatic COVID-19 infection was 0.13%. More than 90% of patients had residential addresses within a 67-mile geographic radius of our medical center, the median age was 58, and there was equal male/female distribution.

Conclusion: These data demonstrating low levels (0.13% prevalence) of COVID-19 infection in an asymptomatic population of patients undergoing scheduled surgeries/procedures in a large urban area have helped to inform perioperative protocols during the COVID-19 pandemic. Testing protocols like ours may prove valuable for other health systems in their approaches to safe procedural practices during COVID-19.

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Figures

**Fig 1**
UCLA Health universal COVID-19 testing protocol and operative/procedural algorithms.

**Fig 2**
Age distributions of test population and LA County population (data for LA County demographics obtained from 2018 United States Census Bureau at data.census.gov¹⁹).

**Fig 3**
Surveillance pre-operative/pre-procedure COVID-19 RT-PCR testing.

See this image and copyright information in PMC

References

1. Chen Z., Zhang Q., Lu Y. Distribution of the COVID-19 epidemic and correlation with population emigration from Wuhan, China. Chin Med J (Engl) 2020;133:1044–1050. - PMC - PubMed
1. Rothan H.A., Byrareddy S.N. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020;109:102433. - PMC - PubMed
1. Centers for Disease Control and Prevention (CDC) Human coronavirus types. 2020. https://www.cdc.gov/coronavirus/types.html
1. Heneghan C., Brassey J., Jefferson T. COVID-19: What proportion are asymptomatic? 2020. https://www.cebm.net/covid-19/covid-19-what-proportion-are-asymptomatic/
1. Johns Hopkins University and Medicine Coronavirus resource center. 2020. https://coronavirus.jhu.edu/

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Low prevalence (0.13%) of COVID-19 infection in asymptomatic pre-operative/pre-procedure patients at a large, academic medical center informs approaches to perioperative care

Affiliations

Low prevalence (0.13%) of COVID-19 infection in asymptomatic pre-operative/pre-procedure patients at a large, academic medical center informs approaches to perioperative care

Authors

Affiliations

Abstract

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References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous