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Fiorelli S, Menna C, Piccioni F, Zuanetti G, Valenza F, Rispoli M, Amore D, Rocco M, Rendina EA, Ibrahim M, Massullo D. Preoperative SARS-CoV-2 Infection Screening before Thoracic Surgery during COVID-19 Pandemic: A Multicenter Retrospective Study. Int J Clin Pract 2023; 2023:8993295. [PMID: 36915634 PMCID: PMC10008108 DOI: 10.1155/2023/8993295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 01/17/2023] [Accepted: 02/04/2023] [Indexed: 03/07/2023] Open
Abstract
OBJECTIVES During coronavirus disease (COVID-19) pandemic, preoperative screening before thoracic surgery is paramount in order to protect patients and staff from undetected infections. This study aimed to determine which preoperative COVID-19 screening tool was the most effective strategy before thoracic surgery. METHODS This retrospective cohort multicenter study was performed at 3 Italian thoracic surgery centers. All adult patients scheduled for thoracic surgery procedures from 4th March until 24th April, 2020, and submitted to COVID-19 preoperative screenings were included. The primary outcome was the yield of screening of the different strategies. RESULTS A total of 430 screenings were performed on 275 patients; 275 anamnestic questionnaires were administered. 77 patients were screened by an anamnestic questionnaire and reverse transcriptase polymerase chain reaction (RT-PCR). 78 patients were selected to combine screening with anamnestic questionnaire and chest computed tomography (CT). The positive yield of screening using a combination of anamnestic questionnaire and RT-PCR was 7.8% (95% CI: 2.6-14.3), while using a combination of anamnestic questionnaire and chest CT was 3.8% (95% CI: 0-9). Individual yields were 1.1% (95% CI: 0-2.5) for anamnestic questionnaire, 5.2% (95% CI: 1.3-11.7) for RT-PCR, and 3.8% (95% CI: 0-9). CONCLUSIONS The association of anamnestic questionnaire and RT-PCR is able to detect around 8 positives in 100 asymptomatic patients. This combined strategy could be a valuable preoperative SARS-CoV-2 screening tool before thoracic surgery.
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Affiliation(s)
- Silvia Fiorelli
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa 1035 00189, Rome, Italy
| | - Cecilia Menna
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa 1035 00189, Rome, Italy
| | - Federico Piccioni
- Anesthesia and Intensive Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gabriele Zuanetti
- School of Anesthesia and Intensive Care, University of Milan, Milan, Italy
| | - Franco Valenza
- Department of Anesthesia, Intensive Care and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Oncohematology, University of Milan, Milan, Italy
| | - Marco Rispoli
- Anesthesia and Intensive Care, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Dario Amore
- Thoracic Surgery, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Monica Rocco
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa 1035 00189, Rome, Italy
| | - Erino Angelo Rendina
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa 1035 00189, Rome, Italy
| | - Mohsen Ibrahim
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa 1035 00189, Rome, Italy
| | - Domenico Massullo
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa 1035 00189, Rome, Italy
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de Bock E, Filipe MD, Simmermacher RKJ, Kroese AC, Vriens MR, Richir MC. Meta-analysis of COVID-19 prevalence during preoperative COVID-19 screening in asymptomatic patients. BMJ Open 2022; 12:e058389. [PMID: 35798523 PMCID: PMC9263349 DOI: 10.1136/bmjopen-2021-058389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] 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.
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Affiliation(s)
- Ellen de Bock
- Department of Surgery, Cancer Centre, University Medical Centre, Utrecht, The Netherlands
| | - Mando D Filipe
- Department of Surgery, Cancer Centre, University Medical Centre, Utrecht, The Netherlands
| | | | - A Christiaan Kroese
- Department of Anaesthesiology, University Medical Centre, Utrecht, The Netherlands
| | - Menno R Vriens
- Department of Surgery, Cancer Centre, University Medical Centre, Utrecht, The Netherlands
| | - Milan C Richir
- Department of Surgery, Cancer Centre, University Medical Centre, Utrecht, The Netherlands
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Mei‐Dan E, Satkunaratnam A, Cahan T, Leung M, Katz K, Aviram A. Questionnaire-based vs universal PCR testing for SARS-CoV-2 in women admitted for delivery. Birth 2021; 48:96-103. [PMID: 33263210 PMCID: PMC7753601 DOI: 10.1111/birt.12520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/13/2020] [Accepted: 11/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND It has been suggested that women admitted for delivery should have universal PCR testing for SARS-CoV-2. Yet, the considerable difference in the incidence of COVID-19 between different geographic regions may affect screening strategies. Therefore, we aimed to compare questionnaire-based testing versus universal PCR testing for SARS-CoV-2 in women admitted for delivery. METHODS A prospective cohort study of women admitted for delivery at a single center during a four-week period (April 22-May 25, 2020). All women completed a questionnaire about COVID-19 signs, symptoms, or risk factors, and a nasopharyngeal swab for PCR for SARS-CoV-2. Women who were flagged as suspected COVID-19 by the questionnaire (questionnaire-positive) were compared with women who were not flagged by the questionnaire (questionnaire-negative). RESULTS Overall, 446 women were eligible for analysis, of which 54 (12.1%) were questionnaire-positive. PCR swab detected SARS-CoV-2 in four (0.9%) women: 3 of 392 (0.8%) in the questionnaire-negative group, and 1 of 54 (1.9%) in the questionnaire-positive group (P = .43), yielding a number needed to screen of 92 (95% CI 62-177). In 96% of the cases, the PCR results were obtained only in the postpartum period. No positive PCR results were obtained from neonatal testing for SARS-CoV-2. The sensitivity of the questionnaire was 75.0%, and the negative predictive value was 99.7%. CONCLUSIONS Although the rate of positive PCR results was not significantly different between the groups, the number needed to screen is considerably high. The use of questionnaire-based PCR testing in areas with low incidence of COVID-19 allows for a reasonable allocation of resources and is easy to implement.
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Affiliation(s)
- Elad Mei‐Dan
- Department of Obstetrics and Gynecology, North York General HospitalUniversity of TorontoTorontoONCanada,Division of Maternal‐Fetal MedicineDepartment of Obstetrics and GynecologySunnybrook Health Sciences CentreUniversity of TorontoTorontoONCanada
| | - Abheha Satkunaratnam
- Department of Obstetrics and Gynecology, North York General HospitalUniversity of TorontoTorontoONCanada
| | - Tal Cahan
- Department of Obstetrics and Gynecology, North York General HospitalUniversity of TorontoTorontoONCanada
| | - Marian Leung
- Department of Obstetrics and Gynecology, North York General HospitalUniversity of TorontoTorontoONCanada
| | - Kevin Katz
- Infection Prevention and ControlNorth York General HospitalUniversity of TorontoTorontoONCanada
| | - Amir Aviram
- Division of Maternal‐Fetal MedicineDepartment of Obstetrics and GynecologySunnybrook Health Sciences CentreUniversity of TorontoTorontoONCanada
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Faried A, Hidajat NN, Harsono AB, Giwangkancana GW, Hartantri Y, Imron A, Arifin MZ. Delayed definitive treatment of life-threatening neurosurgery patient with suspected coronavirus disease 2019 infection in the midst of pandemic: Report of two cases. Surg Neurol Int 2021; 12:18. [PMID: 33500833 PMCID: PMC7827364 DOI: 10.25259/sni_828_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/17/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic has affected global health system; in the context of the COVID-19 pandemic, both surgeon and anesthesiologist often dealt with emergency situation, optimal timing of surgery and safety protocol in hospital setting must be implemented with many facets for both patients and health-care providers. CASE DESCRIPTION We reported two cases. Case#1 - A 16-year-old male was referred to our hospital, due to a decreased of consciousness following a motor vehicle accident. Head CT scan revealed an epidural hemorrhage on the left temporoparietal. The patient was suspected for having COVID-19 from the reactivity of his serum against SARS-CoV-2 antigen. Procedures for the confirmation of COVID-19 and surgical preparation caused 12 h delayed from the admission. Nevertheless, the patient was deteriorated clinically before he was transported to the operating room and died after 6 cycles of cardiopulmonary resuscitation. Case#2 - A 25-year-old male was referred to RSHS, due to a decreased of consciousness, diagnosed as bilateral proximal shunt exposed with suspected COVID-19; delay occurred due to unavailability of negative pressure intensive unit for postoperative care. This caused 5760 h (4 days) delayed for bilateral shunt removal and temporary extraventricular drainage. CONCLUSION Optimal timing of surgery, a good safety, and health protocol during pandemic in emergency setting are an obligation to protect health providers and patients. A decision-making plan must be organized precisely to maintain alertness, achieve the highest possible standard of care, and outcome in emergency surgical cases. Lack of monitoring must be abated to avoid fatality for patient, especially in emergency surgery setting.
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Affiliation(s)
- Ahmad Faried
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
- Stem Cell Unit, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Nucki Nursjamsi Hidajat
- Stem Cell Unit, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
- Department of Orthopaedics and Traumatology, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Ali Budi Harsono
- Stem Cell Unit, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Gezy Weita Giwangkancana
- Department of Anesthesiology and Intensive Care Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Yovita Hartantri
- Department of Internal Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Akhmad Imron
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Muhammad Zafrullah Arifin
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
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Jangra K, Manohar N, Bidkar PU, Vanamoorthy P, Gupta D, Rath GP, Monteiro J, Panda N, Sriganesh K, Hrishi AP, Das B, Yadav R. Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) Position Statement and Advisory for the Practice of Neuroanesthesia during COVID-19 Pandemic. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2020. [DOI: 10.1055/s-0040-1714186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AbstractThe coronavirus disease 2019 (COVID-19) is a major health emergency in today’s time. In December 2019, a cluster of pneumonia cases in Wuhan, China was attributed to a novel coronavirus. The World Health Organization declared it as a pandemic. As the majority of the cases suffering from COVID-19 are mildly symptomatic or asymptomatic, it becomes a great challenge to identify the infected persons in the absence of extensive testing. In the hospital environment, it can infect several other vulnerable patients and healthcare providers, significantly impacting the hospital services. Anesthesiologists are at an increased risk of COVID-19 transmission from the patients, as they are frequently involved in several aerosol-generating procedures. It is not possible to identify asymptomatic COVID-19 patients solely based on history-taking during their first point of contact with the anesthesiologists at the preanesthetic checkup clinic.Most of the neurosurgical conditions are of urgent in nature and cannot be postponed for a longer duration. In view of this, the position statement and practice advisory from the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) provides guidance to the practice of neuroanesthesia in the present scenario. The advisory has been prepared considering the current disease status of the COVID-19 pandemic, available literature, and consensus from experts in the field of neuroanesthesiology. Since the pandemic is still progressing and the nature of the disease is dynamic, readers are advised to constantly look for updated literature from ISNACC and other neurology and neurosurgical societies.
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Affiliation(s)
- Kiran Jangra
- Division of Neuroanaesthesia, Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nitin Manohar
- Department of Neuroanaesthesia and Neurocritical Care, Yashoda Hospitals, Secunderabad, Telangana, India
| | - Prasanna U. Bidkar
- Division of Neuroanesthesiology, Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ponniah Vanamoorthy
- Department of Neuroanesthesiology and Neurocritical Care, MGM Health Care Pvt Ltd, Chennai, Tamil Nadu, India
| | - Devendra Gupta
- Department of Anesthesiology and Critical Care, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Girija P. Rath
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Joseph Monteiro
- Department of Anaesthesiology, P D Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Nidhi Panda
- Division of Neuroanaesthesia, Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamath Sriganesh
- Department of Neuroanaesthesiology and Neurocritical Care, National Institute of Mental Health Neurosciences, Bengaluru, Karnataka, India
| | - Ajay P. Hrishi
- Division of Neuroanesthesiology, Department of Anesthesiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvanathapuram, India
| | - Bhibukalyani Das
- Department of Neuroanaesthesia, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Rahul Yadav
- Department of Anaesthesia, INHS Asvini, Mumbai, Maharashtra, India
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