Self-quarantine programme and pre-operative SARS-CoV-2 PCR screening for orthopaedic elective surgery: experience from Japan

Abstract

Purpose: This study aimed to evaluate the acceptability of 14 days of self-quarantine and the positivity rate of pre-operative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) screening for patients undergoing elective orthopaedic surgery.

Methods: The self-quarantine programme and pre-operative SARS-CoV-2 PCR screening were initiated for patients who were scheduled for admission later than 7 May 2020 for elective orthopaedic surgery on admission. On the day of admission, the patients declared compliance with self-quarantine regulations. The admission was refused in cases of non-compliance. After admission, the patients underwent SARS-CoV-2 PCR screening. If PCR results were negative, isolation was terminated. If PCR results were positive, the surgery was postponed. If the patients had symptoms suspicious of coronavirus disease (COVID-19) after surgery, the PCR test was repeated.

Results: Overall, 308 patients (age: 63.2 ± 18.8 years, 197 female and 111 male) were scheduled for elective orthopaedic surgery. Two patients did not agree with the requirements of self-quarantine, and two other procedures were cancelled. No non-compliance was reported; thus, the completion rate of the self-quarantine programme was 304/308 (98.7%). Finally, 304 patients underwent PCR testing, and there were no positive PCR results. After cancellations of four operations due to reasons other than COVID-19, 300 surgical procedures were performed. No patients developed COVID-19 during hospitalisation.

Conclusions: Although this system is based on trusting the good behaviour of patients, accompanied by PCR screening, we believe that the results showed the efficacy of the system in safely performing orthopaedic surgery during the COVID-19 pandemic.

Keywords: COVID-19; Elective surgery; Orthopaedics; PCR; SARS-CoV-2; Self-quarantine.

Fig. 1

Flowchart of the self-quarantine programme and pre-operative SARS-CoV-2 PCR screening. Processes before and after admission are illustrated on the blue and orange backgrounds, respectively

Fig. 2

The number of cases with COVID-19 in Japan from 16th January to 31st October 2020 [26]. A state of emergency was proclaimed in several metropolitan areas in Japan, including Kyoto on 6th April, and lifted 21st May 2020