key: cord-0944111-0g69i0ye
authors: Singh, Harsh; Isak, Inis; Knapik, Derrick M.; Vadhera, Amar S.; Gursoy, Safa; Cole, Brian J.; Verma, Nikhil N.
title: No Patients Having Elective Outpatient Orthopaedic Surgery Performed in an Ambulatory Surgery Center Using Preoperative Screening Protocols During the Coronavirus Pandemic Developed COVID-19
date: 2021-05-12
journal: Arthrosc Sports Med Rehabil
DOI: 10.1016/j.asmr.2021.05.001
sha: 2cb84d893fa92f5c6e695a308d9b8265c3de2a66
doc_id: 944111
cord_uid: 0g69i0ye

Purpose The purpose of this study is to determine the safety of elective, outpatient orthopaedic sports procedures during the Coronavirus (COVID-19) pandemic at a high-volume orthopaedic practice. Methods All patients who were scheduled for elective, outpatient orthopaedic sports medicine procedures at one of two of outpatient surgical centers between July 1, 2020 and December 31, 2020 were asked to complete a custom survey during a post-operative clinic visit or phone call at a minimum of two-weeks or were subject to a routine screening questionnaire and temperature screen at the time of the first post-operative follow-up visit. The survey questionnaire assessed for any COVID-19-related symptoms. Surgical case logs were retrieved to review for any cancelled surgeries due to a positive pre-operative COVID-19 test. Results A total of 3.5% of patients (n=39/1119) scheduled for surgery were diagnosed with COVID-19 during preoperative testing, resulting in surgical cancellation. Patients with a positive pre-operative COVID-19 test were found to be significantly younger (46 ± 20 years) when compared to all other patients with a negative test (51 ± 21 years; p=0.002). No patient was diagnosed with COVID-19, reported symptoms concerning for COVID infection, underwent additional testing, or reported close contact with another individual with a positive test or possessed symptoms concerning for COVID-19 at a minimum of two-weeks post-operatively. Conclusion This study found that 3.5% of patients tested positive for COVID-19 and were significantly younger when compared to patients testing negative. No patient investigated for potential infection post-operatively reported the development of any symptoms related to COVID-19 or reported a positive test post-operatively. Using current protocols for pre-operative screening, elective outpatient orthopaedic surgery performed in an ASC is safe with no documented cases of COVID-19 transmission in this cohort.

19 positive following surgery [1] . Meanwhile, the COVID-19 positivity rate for patients 55 undergoing elective plastic surgery procedures has been estimated to be approximately 0.13% 56 During the COVID-19 pandemic, there has been a substantial impact on orthopaedic services, 63 with significant reduction in surgical case volume and revenue [4] . Patient fear of contracting the 64 COVID-19 virus has been cited as the primary factor behind the decrease in operative volume 65 [5] . A preliminary study reported that patients (n=34) contracting the COVID-19 virus following 66 elective orthopaedic surgery demonstrated a 20% mortality rate [3] . Delay or avoidance of 67 elective procedure can have substantial impact on patients including loss of recreational capacity, 68 negative emotional impact and potential inability to work with resulting financial implications. were assigned a study identification number and all data were deidentified. All patients who 85

were scheduled for elective, outpatient orthopaedic sports medicine procedure at one of two 86 outpatient surgical centers between July 1, 2020 and December 31, 2020 were identified using an Surgical case logs were retrieved to review for any cancelled surgeries due to a positive pre-110 operative COVID-19 PCR test or concern for potential COVID-19 exposure. This list was cross-111 referenced with a cancelled case log from each ambulatory surgical center. Chart review was 112 performed in these patients to obtain basic demographic data, including age and procedure type. The primary results from this investigation were that from July 2020-December 2020, a total of 175 1119 patients were scheduled for elective, outpatient orthopaedic sports procedures, of which 176 3.5% (n=39/1119) were found to be positive for COVID-19 prior to surgery. Patients testing 177 positive were significantly younger when compared to patients who tested negative. We orthopaedic procedures will continue to increase, posing increased concern for risks to healthcare 186 providers and the patients treated. As such, elective surgical protocols have been developed in an 187 attempt to limit the risk of any COVID-19 transmission during the surgical episode. Although 188 these protocols were designed using intuitive protocols, the effectiveness of the protocols is Additionally, the patients who were surveyed for symptoms during routine post-operative 245 evaluation had an average follow-up length of less than 14 days. However, a prior study reported 246 average onset of symptoms after COVID-19 exposure to be close to five days [17] . Finally, 247 patients did not receive post-operative testing, and therefore cases that occurred but were 248 asymptomatic may have been missed. Finally, the study was performed in regard to cases 249 performed in an outpatient ambulatory surgical center and therefore cannot be extrapolated to 250 hospital-based surgery. 

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