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Puylaert CAJ, Scheijmans JCG, Borgstein ABJ, Andeweg CS, Bartels-Rutten A, Beets GL, van Berge Henegouwen MI, Braak SJ, Couvreur R, Daams F, van Es HW, Franken LC, Grotenhuis BA, Hendriks ER, de Hingh IHJT, Hoeijmakers F, Ten Holder JT, Huisman PM, Kazemier G, van Kesteren F, van Kesteren J, Keywani K, Kuiper SZ, Lange MDJ, Lobatto ME, du Mée AWF, Poeze M, van Praag EM, van Rossen J, van Santvoort HC, Sedee WJA, Seelen LWF, Sharabiany S, Sosef NL, Quanjel MJR, Veltman J, Verhagen T, van de Vlasakker VCJ, Weeder PD, van Werven JR, Wesdorp NJ, van Dieren S, Han AX, Russell CA, de Jong MD, Bossuyt PMM, Quarles van Ufford JME, Prokop MW, Gisbertz SS, Prins JM, Besselink MG, Boermeester MA, Gietema HA, Stoker J. Yield of Screening for COVID-19 in Asymptomatic Patients Before Elective or Emergency Surgery Using Chest CT and RT-PCR (SCOUT): Multicenter Study. Ann Surg 2020; 272:919-924. [PMID: 33021367 PMCID: PMC7668335 DOI: 10.1097/sla.0000000000004218] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine the yield of preoperative screening for COVID-19 with chest CT and RT-PCR in patients without COVID-19 symptoms. SUMMARY OF BACKGROUND DATA Many centers are currently screening surgical patients for COVID-19 using either chest CT, RT-PCR or both, due to the risk for worsened surgical outcomes and nosocomial spread. The optimal design and yield of such a strategy are currently unknown. METHODS This multicenter study included consecutive adult patients without COVID-19 symptoms who underwent preoperative screening using chest CT and RT-PCR before elective or emergency surgery under general anesthesia. RESULTS A total of 2093 patients without COVID-19 symptoms were included in 14 participating centers; 1224 were screened by CT and RT-PCR and 869 by chest CT only. The positive yield of screening using a combination of chest CT and RT-PCR was 1.5% [95% confidence interval (CI): 0.8-2.1]. Individual yields were 0.7% (95% CI: 0.2-1.1) for chest CT and 1.1% (95% CI: 0.6-1.7) for RT-PCR; the incremental yield of chest CT was 0.4%. In relation to COVID-19 community prevalence, up to ∼6% positive RT-PCR was found for a daily hospital admission rate >1.5 per 100,000 inhabitants, and around 1.0% for lower prevalence. CONCLUSIONS One in every 100 patients without COVID-19 symptoms tested positive for SARS-CoV-2 with RT-PCR; this yield increased in conjunction with community prevalence. The added value of chest CT was limited. Preoperative screening allowed us to take adequate precautions for SARS-CoV-2 positive patients in a surgical population, whereas negative patients needed only routine procedures.
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Affiliation(s)
- Carl A J Puylaert
- Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jochem C G Scheijmans
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Alexander B J Borgstein
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | - Geerard L Beets
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sicco J Braak
- Department of Radiology, Hospital Group Twente, Almelo, the Netherlands
| | - Roy Couvreur
- Department of Surgery, Haaglanden Medical Center, Den Haag, the Netherlands
| | - Freek Daams
- Department of Surgery, Cancer Center Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Hendrik W van Es
- Department of Radiology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Lotte C Franken
- Department of Surgery, Flevo Hospital, Almere, the Netherlands
| | - Brechtje A Grotenhuis
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Eduard R Hendriks
- Department of Surgery, Tergooi Hospitals, Hilversum, the Netherlands
| | | | | | - Joris T Ten Holder
- Department of Pulmonary Medicine, Haaglanden Medical Center, Den Haag, the Netherlands
| | - Peter M Huisman
- Department of Radiology, Tergooi Hospitals, Hilversum, the Netherlands
| | - Geert Kazemier
- Department of Surgery, Cancer Center Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Floortje van Kesteren
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Kammy Keywani
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sara Z Kuiper
- Department of Surgery, Maastricht UMC+, Maastricht, the Netherlands
| | - Maurits D J Lange
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mark E Lobatto
- Department of Radiology, Spaarne Gasthuis, Haarlem and Hoofddorp, the Netherlands
| | | | - Martijn Poeze
- Department of Surgery, Maastricht UMC+, Maastricht, the Netherlands
| | - Elise M van Praag
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jorit van Rossen
- Department of Radiology, Hospital Group Twente, Almelo, the Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands
- Department of Surgery, UMC Utrecht Cancer Center, UMC Utrecht, Utrecht, the Netherlands
| | - Wouter J A Sedee
- Department of Emergency Medicine, St Jansdal Hospital, Harderwijk, the Netherlands
| | - Leonard W F Seelen
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Sarah Sharabiany
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Nico L Sosef
- Department of Surgery, Spaarne Gasthuis, Haarlem and Hoofddorp, the Netherlands
| | - Marian J R Quanjel
- Department of Pulmonary Medicine, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Jeroen Veltman
- Department of Radiology, Hospital Group Twente, Almelo, the Netherlands
| | - Tim Verhagen
- Department of Surgery, Hospital Group Twente, Almelo, the Netherlands
| | | | - Pepijn D Weeder
- Department of Surgery, Spaarne Gasthuis, Haarlem and Hoofddorp, the Netherlands
| | | | - Nina J Wesdorp
- Department of Surgery, Cancer Center Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Susan van Dieren
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Alvin X Han
- Laboratory of Applied Evolutionary Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Colin A Russell
- Laboratory of Applied Evolutionary Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Menno D de Jong
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick M M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | - Suzanne S Gisbertz
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Hester A Gietema
- Department of Radiology, Maastricht UMC+, Maastricht, the Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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van Praag EM, Stellingwerf ME, van der Bilt JDW, Bemelman WA, Gecse KB, Buskens CJ. Ligation of the Intersphincteric Fistula Tract and Endorectal Advancement Flap for High Perianal Fistulas in Crohn's Disease: A Retrospective Cohort Study. J Crohns Colitis 2020; 14:757-763. [PMID: 31696918 PMCID: PMC7346888 DOI: 10.1093/ecco-jcc/jjz181] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Ligation of the intersphincteric fistula tract [LIFT] and advancement flap [AF] procedures are well-established, sphincter-preserving procedures for closure of high perianal fistulas. As surgical fistula closure is not commonly offered in Crohn's disease patients, long-term data are limited. This study aims to evaluate outcomes after LIFT and AF in Crohn's high perianal fistulas. METHODS All consecutive Crohn's disease patients ≥18 years old treated with LIFT or AF between January 2007 and February 2018 were included. The primary outcome was clinical healing and secondary outcomes included radiological healing, recurrence, postoperative incontinence and Vaizey Incontinence Score. RESULTS Forty procedures in 37 patients [LIFT: 19, AF: 21, 35.1% male] were included. A non-significant trend was seen towards higher clinical healing percentages after LIFT compared to AF [89.5% vs 60.0%; p = 0.065]. Overall radiological healing rates were lower for both approaches [LIFT 52.6% and AF 47.6%]. Recurrence rates were comparable: 21.1% and 19.0%, respectively. In AF a trend was seen towards higher clinical healing percentages when treated with anti-tumour necrosis factor/immunomodulators [75.0% vs 37.5%; p = 0.104]. Newly developed postoperative incontinence occurred in 15.8% after LIFT and 21.4% after AF. Interestingly, 47.4% of patients had a postoperatively improved Vaizey Score [LIFT: 52.9% and AF: 42.9%]. The mean Vaizey Score decreased from 6.8 [SD 4.8] preoperatively to 5.3 [SD 5.0] postoperatively [p = 0.067]. CONCLUSIONS Both LIFT and AF resulted in satisfactory closure rates in Crohn's high perianal fistulas. However, a discrepancy between clinical and radiological healing rates was found. Furthermore, almost half of the patients benefitted from surgical intervention with respect to continence.
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Affiliation(s)
- Elise M van Praag
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam,the Netherlands
| | - Merel E Stellingwerf
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam,the Netherlands
| | - Jarmila D W van der Bilt
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam,the Netherlands
| | - Wilhelmus A Bemelman
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam,the Netherlands
| | - Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, the Netherlands
| | - Christianne J Buskens
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam,the Netherlands,Corresponding author: C. J. Buskens MD, PhD, Amsterdam UMC, Department of Surgery, Post box 22660, 1100 DD Amsterdam, The Netherlands. Tel.: 0031 20 566 6818; Fax: 0031 20 566 6569;
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