key: cord-0965313-36hxzjn8
authors: Asadi, Nizar; Mayer, Nora; Perikleous, Periklis; Doukas, George; Finch, Jonathan; Beddow, Emma; Anikin, Vladimir
title: A brief report from a Thoracic surgery tertiary centre in UK during the COVID‐19 outbreak: Do we really need CT‐scan prior to surgery?
date: 2020-08-26
journal: Br J Surg
DOI: 10.1002/bjs.11887
sha: bdaf2c8f0a933fb58a0aee078f61ee39cb51567d
doc_id: 965313
cord_uid: 36hxzjn8

nan

Coronavirus disease 2019 (COVID-19) has dramatically affected health care systems globally and has led to extremely rapid changes in routine practice 1 . Every patient admitted to hospital following the outbreak has to be investigated for the disease and managed accordingly; various guidelines have been introduced internationally. COVID-19 infection can be diagnosed, according the World Health Organization (WHO), with detection of unique sequences of SARS-CoV-2 virus RNA by Nucleic Acid Amplification Test (NAAT), using a method of reverse-transcription polymerase chain reaction (RT-PCR) 2 . Even though several publications have documented that High-Resolution Computed Tomography (HRCT) may be helpful in detection of an early stage COVID-19 infection, the role of computed tomography scan (CT-scan) in early diagnosis of the disease remains debatable 3, 4 .

Taking current knowledge into consideration, to be able to continue providing elective service in our thoracic surgical department, we designed and implemented our own protocol which consisted of a pre-admission questionnaire and nasopharyngeal swabs for COVID-19 testing. Patients were not subjected to pre-operative CT-scans, because we did not consider this would add further value to our formulated screening strategy. Via telephone communication, every patient scheduled for an elective procedure was asked to complete a questionnaire to ensure absence of COVID-19 related symptoms within the previous 14 days. Patients with reported symptoms had their surgery postponed for 14 days while patients with no reported symptoms were seen at the department 48 hours prior to surgery where they underwent routine pre-operative blood analysis, including C-reactive protein, and nasopharyngeal swabs for COVID-19 testing. They were then asked to isolate at home and return to hospital the day prior to surgery. On the day of admission, a second nasopharyngeal swab was performed. To proceed with surgery, patients needed to have two negative results for SARS-CoV-2 virus on RT-PCR.

Between 17th March -11th May 2020 we performed 80 elective cases of thoracic surgery in our department. Patients had a mean age of 65 years (SD ± 12⋅29) and 42 (52⋅50%) were males. Bronchoscopic procedures were performed for 25 patients (31⋅25%). Thoracic surgery was performed in 55 patients (68⋅75%), of which 3 (5⋅45%) underwent cervical mediastinoscopy and 32 (40⋅00%) underwent pulmonary resections (22 anatomical, 10 nonanatomical).

Mediastinoscopy was performed via a transverse cervical incision and lung resections were performed either via standard thoracotomy (n = 14) or Video Assisted Thoracoscopic Surgery (VATS) (n = 38). Overall, 34 patients (42⋅50%) were diagnosed with primary lung cancer, 7 (8⋅75%) with pulmonary metastases, 10 (12⋅50%) with bronchial carcinoid or other airway tumours, 8 (10⋅00%) with benign bronchial stricture, 3 (3⋅75%) with mesothelioma, 4 (5⋅00%) with benign pleural effusions and 14 (17⋅50%) with other chest pathologies. No patients were diagnosed with COVID-19 during the postoperative period and there were no admissions to intensive care with symptoms of pneumonia or respiratory failure. Two patients (2⋅50%) developed postoperative pneumonia but resulted negative on repeat RT-PCR test. One (1,25%) patient underwent a CT-scan following sudden onset of breathlessness, which ruled out COVID-19 and pulmonary embolism. Another patient (1⋅25%) required non-invasive ventilation for respiratory failure post bronchoscopy.

Based on our experience during the challenging time of the COVID-19 pandemic we want to highlight that although we have not considered chest CT-scan prior to surgery, none of our patients had any complications related to COVID-19 during their post-operative course. We support the new guidelines of the Royal College of Surgeons of England, which recommend that patients undergoing elective thoracic surgery should not be undergoing CT-scan to exclude SARS-CoV-2 virus infection. Adequate anamnesis, self-isolation and negative RT-PCR testing are the most important factors to exclude COVID-19 prior to surgery.

Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services

World Health Organization. Laboratory testing for coronavirus disease 2019 (COVID-19) in suspected human cases

Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR

Chest CT for Typical 2019-NCoV Pneumonia: Relationship to Negative RT-PCR Testing