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Meta-Analysis
. 2022 Jul 7;12(7):e058389.
doi: 10.1136/bmjopen-2021-058389.

Meta-analysis of COVID-19 prevalence during preoperative COVID-19 screening in asymptomatic patients

Ellen de Bock  1 , Mando D Filipe  2 , Roger K J Simmermacher  3 , A Christiaan Kroese  4 , Menno R Vriens  2 , Milan C Richir  2
Affiliations
Meta-Analysis

Meta-analysis of COVID-19 prevalence during preoperative COVID-19 screening in asymptomatic patients

Ellen de Bock et al. BMJ Open. .

Abstract

Objectives: Patients with COVID-19 may be asymptomatic and are able to transmit COVID-19 during a surgical procedure, resulting in increased pressure on healthcare and reduced control of COVID-19 spread. There remains uncertainty about the implementation of preoperative screening for COVID-19 in asymptomatic surgical patients. Therefore, this study aims to determine the prevalence of preoperative COVID-19, confirmed by reverse transcriptase PCR (RT-PCR), in asymptomatic patients.

Design: Systematic review and meta-analysis.

Data sources: Pubmed and Embase databases were searched through 20 February 2022.

Eligibility criteria: All COVID-19 articles including preoperative asymptomatic patients were included.

Data extraction and synthesis: Two independent reviewers extracted data and assessed risk of bias. Meta-analysis was performed to determine the prevalence of COVID-19 with 95% CI. Moreover, estimated positive predictive value (PPV), negative predictive value, false-positives (FP) and false-negatives were calculated for preoperative asymptomatic patients.

Results: Twenty-seven studies containing 27 256 asymptomatic preoperative screened patients were included, of which 431 were positive for COVID-19 by RT-PCR test. In addition, the meta-analysis revealed a pooled COVID-19 prevalence of 0.76% (95% CI 0.36% to 1.59%). The calculated PPV for this prevalence is 40.8%.

Conclusions: The pooled COVID-19 prevalence in asymptomatic patients tested preoperatively was 0.76%, with low corresponding PPV. Consequently, nearly three-quarters of postponed surgical procedures in asymptomatic preoperative patients may be FP. In the event of similar pandemics, modification of preoperative mandatory RT-PCR COVID-19 testing in asymptomatic patients may be considered.

Keywords: COVID-19; infection control; surgery.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart showing literature search and study selection with 27 relevant studies included. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RT-PCR, reverse transcriptase PCR.
Figure 2
Figure 2
Forest plot of the prevalence (%) of asymptomatic COVID-19 positive patients in the preoperative setting.
See this image and copyright information in PMC

References

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