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Global study suggests routine COVID-19 testing of elective surgery patients can save lives

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A study involving researchers from around the world, including London, Ont., suggests that testing patients for COVID-19 before major elective surgery in regions experiencing a high spread of the virus can reduce the risk of respiratory complications and save lives.

The researchers say testing allows surgeons to identify people with COVID-19 who are asymptomatic and to then postpone their surgeries, avoiding the risk of severe COVID-19 complications after an operation.

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As well, researchers say routine testing helps prevent the virus from spreading to other patients.

“In Canada, nasal swab testing is routinely used before surgery in regions where COVID-19 is circulating, though not universally,” said Western University professor and CovidSurg Collaborative researcher, Janet Martin.

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CovidSurg Collaborative lead, Dr. Aneel Bhangu, who is with the University of Birmingham in the United Kingdom, says the findings “demonstrate major variation between countries” when it comes to testing before operations.

“Whilst a clear benefit to testing was seen, just one in four patients were screened for infection. This illustrates the need for global expansion and standardization of swab testing worldwide.”

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The study involved 8,784 patients from 432 hospitals in 53 countries. The results state that pulmonary complications occurred in 3.9 per cent of patients while COVID-19 was confirmed in 2.6 per cent.

“After risk adjustment, having at least one negative preoperative nasopharyngeal swab test,” researchers say, “was associated with a lower rate of pulmonary complications.” Swab testing was “beneficial before major surgery” and in COVID-19 hot spot areas, “but not before minor surgery or in low-risk areas.”

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Martin added that testing turnaround times and supply chain issues can provide challenges, but “we now have the evidence required to prioritize testing in regions where COVID-19 incidence is high, and to deprioritize routine testing in regions where COVID-19 is rare.”

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Researchers are using the findings in this study, published in the British Journal of Surgery, as well as findings from other studies out of the CovidSurg Collaborative to create a “dedicated toolkit to guide hospitals in keep elective surgery up and running safely.”

Previously, researchers found that having “COVID-19-free” areas in hospitals could prevent tens of thousands of surgical patients from experiencing complications or death in Canada alone.

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The toolkit will help hospitals and health-care providers worldwide “get elective surgery up and running again,” researchers say.

“To date, most recommendations to guide surgical decisions during the pandemic around the world have largely been opinion-based, given the lack of studies early on,” said Martin.

“Now that we have completed a number of studies, we created the surgical toolkit to collect evidence to support evidence-based decisions. The toolkit addresses how to maximize surgical safety and improve outcomes for patients who need surgery during the pandemic, including specific strategies to reduce complications and cancellations.”

The toolkit includes summaries of published data, guides for “effective surgical recovery plans,” and a five-year vision of safe and effective surgery addressing global challenges beyond the pandemic.

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