Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic

James C. Glasbey, Omar Omar, Dmitri Nepogodiev, Ana Minaya-Bravo, Brittany Kay Bankhead-Kendall, Marco Fiore, Kaori Futaba, Rohan R. Gujjuri, Arda Isik, Haytham M.A. Kaafarani, Sivesh K. Kamarajah, Elizabeth Li, Markus W. Löffler, Kenneth A. McLean, Outani Oumaima, Ntirenganya Faustin, Satoi Sohei, Richard Shaw, Joana F.F. Simoes, Grant D. StewartStephen Tabiri, Isobel M. Trout, Aneel A. Bhangu, Kwabena Siaw-Acheampong, Ruth A. Benson, Edward Bywater, Daoud Chaudhry, Brett E. Dawson, Jonathan P. Evans, Emily Heritage, Conor S. Jones, Chetan Khatri, Rachel A. Khaw, James M. Keatley, Andrew Knight, Samuel Lawday, Harvinder S. Mann, Ella J. Marson, Siobhan C. McKay, Emily C. Mills, Gianluca Pellino, Maria Picciochi, Elliott H. Taylor, Abhinav Tiwari, Mary L. Venn, Richard J.W. Wilkin, Bhangu Aneel, Neil J. Smart, Gaetano Gallo, Susan Moug, Francesco Pata, Peter G. Pockney, Salomone Di Saverio, Abigail Vallance, Dale Vimalchandran, Keith Roberts, John Isaac, John Edwards, Aman S. Coonar, Adrian Marchbank, Edward J. Caruana, Georgia R. Layton, Akshay Patel, Alessandro Brunelli, Samuel Ford, Anant Desai, Alessandro Gronchi, Max Almond, Fabio Tirotta, Dumitra Sinziana, Stephen J. Price, Daniel M. Fountain, Michael D. Jenkinson, Peter Hutchinson, Hani J. Marcus, Rory J. Piper, L. Lippa, Franco Servadei, Ignatius Esene, Christian Freyschlag, Iuri Neville, Gail Rosseau, Karl Schaller, Andreas K. Demetriades, Faith Robertson, Alex Alamri, Andrew G. Schache, Stuart C. Winter, Michael Ho, Paul Nankivell, Juan Rey Biel, Martin Batstone, Ian Ganly, Raghavan Vidya, Alex Wilkins, Jagdeep K. Singh, Dinesh Thekinkattil, Sudha Sundar, Christina Fotopoulou, Elaine Leung, Tabassum Khan, Luis Chiva, Sehouli Jalid, Anna Fagotti, Paul Cohen, Murat Gutelkin, Rahel Ghebre, Thomas Konney, Rene Pareja, Rob Bristow, Sean Dowdy, Shylasree T.S. Rajkumar, Joe Ng, Keiiji Fujiwara, Benjamin Lamb, Krishna Narahari, Alan McNeill, Alexandra Colquhoun, John McGrath, Steve Bromage, Ravi Barod, Veeru Kasivisvanathan, Tobias Klatte, Tom E.F. Abbott, Sadi Abukhalaf, Michel Adamina, Adesoji O. Ademuyiwa, Arnav Agarwal, Murat Akkulak, Ehab Alameer, Derek Alderson, Felix Alakaloko, Markus Albertsmeiers, Muhammad Alshaar, Sattar Alshryda, Alexis P. Arnaud, Knut Magneaugestad, Faris Ayasra, José Azevedo, Emma Barlow, David Beard, Ruth Blanco-Colino, Amanpreet Brar, Kerry A. Breen, Chris Bretherton, Igor Lima Buarque, Joshua Burke, Mohammad Chaar, Peter Christensen, Daniel Cox, Moises Cukier, Miguel F. Cunha, Giana H. Davidson, Thomas M. Drake, John G. Edwards, Muhammed Elhadi, Sameh Emile, Farik Shebani, J. Edward Fitzgerald, T. Garmanova, Dhruv Ghosh, Gustavo Mendoncą Ataíde Gomes, Gustavo Grecinos, Ewen A. Griffiths, Madalegna Gründl, Constantine Halkias, Ewen M. Harrison, Intisar Hisham, Peter J. Hutchinson, Shelley Hwang, Pascal Jonker, Debby Keller, Angelos Kolias, Ismail Lawani, Hans Lederhuber, Andrey Litvin, Andrew Loehrer, Maria Aguilera Lorena, Maria Marta Modolo, Piotr Major, Janet Martin, Hassan N. Mashbari, Dennis Mazingi, Symeon Metallidis, Helen M. Mohan, Rachel Moore, David Moszkowicz, Joshua S. Ng-Kamstra, Milagros Niquen, Faustin Ntirenganya, Maricarmen Olivos, Kacimi Oussama, Oumaima Outani, Marie Dione Parreno-Sacdalanm, Carlos Jose Perez Rivera, Thomas D. Pinkney, Willemijn Van Der Plas, Ahmad Qureshi, Dejan Radenkovic, Antonio Ramos De La Medina, April C. Roslani, Martin Rutegård, Juan José Segura-Sampedro, Irène Santos, Raza Sayyed, Andreas A. Schnitzbauer, Justina O. Seyi-Olajide, Neil Sharma, Sebastian Shu, Kjetil Soreide, A. Spinelli, Nsund Mali, Philip Townend, Georgios Tsoulfas, Gabrielle H.Van Ramshorst, Dale Vimalachandran, Oliver J. Warren, Duane Wedderburn, Naomi Wright, Euro Surg, C. Allemand, L. Boccalatte, M. Figari, M. Lamm, J. Larranãga, C. Marchitelli, F. Noll, D. Odetto, M. Perrotta, J. Saadi, L. Zamora, C. Alurralde, E. L. Caram, D. Eskinazi, J. P. Mendoza, M. Usandivaras, R. Badra, A. Esteban, J. S. Garciá, P. M. Garciá, J. I. Gerchunoff, S. M. Lucchini, M. A. Nigra, L. Vargas, T. Hovhannisyan, A. Stepanyan, T. Gould, R. Gourlay, B. Griffiths, S. Gananadha, M. McLaren, J. Cecire, N. Joshi, S. Salindera, A. Sutherland, J. H. Ahn, G. Charlton, S. Chen, N. Gauri, R. Hayhurst, S. Jang, F. Jia, C. Mulligan, W. Yang, G. Ye, H. Zhang, M. Ballal, D. Gibson, D. Hayne, J. Moss, T. Richards, P. Viswambaram, U. G. Vo, J. Bennetts, T. Bright, M. Brooke-Smith, R. Fong, B. Gricks, Y. H. Lam, B. S. Ong, M. Szpytma, D. Watson, K. Bagraith, S. Caird, E. Chan, C. Dawson, D. Ho, E. Jeyarajan, S. Jordan, A. Lim, G. J. Nolan, A. Oar, D. Parker, H. Puhalla, A. Quennell, L. Rutherford, P. Townend, Papen M. Von, M. Wullschleger, A. Blatt, D. Cope, N. Egoroff, M. Fenton, J. Gani, N. Lott, N. Shugg, M. Elliott, D. Phung, D. Phan, D. Townend, C. Bong, J. Gundara, A. Frankel, S. Bowman, G. R. Guerra, J. Bolt, K. Buddingh, N. N. Dudi-Venkata, S. Jog, H. M. Kroon, T. Sammour, R. Smith, C. Stranz, M. Batstone, K. Lah, W. McGahan, D. Mitchell, A. Morton, A. Pearce, M. Roberts, G. Sheahan, B. Swinson, N. Alam, S. Banting, L. Chong, P. Choong, S. Clatworthy, D. Foley, A. Fox, M. W. Hii, B. Knowles, J. Mack, M. Read, A. Rowcroft, S. Ward, G. Wright, M. Lanner, I. Königsrainer, M. Bauer, C. Freyschlag, M. Kafka, F. Messner, D. Öfner, I. Tsibulak, K. Emmanuel, M. Grechenig, R. Gruber, M. Harald, L. Öhlberger, J. Presl, A. Wimmer, I. Namazov, E. Samadov, D. Barker, R. Boyce, S. Corbin, A. Doyle, A. Eastmond, R. Gill, A. Haynes, S. Millar, M. O'Shea, G. Padmore, N. Paquette, E. Phillips, S. John, K. Walkes, N. Flamey, P. Pattyn, W. Oosterlinck, Den Eynde J. Van, Den Eynde R. Van, A. Gatti, C. Nardi, R. Oliva, Cicco R. De, I. Cecconello, P. Gregorio, Lima L. Pontual, Junior U. Ribeiro, F. Takeda, R. M. Terra, M. Sokolov, B. Kidane, S. Srinathan, M. Boutros, N. Caminsky, G. Ghitulescu, G. Jamjoum, J. Moon, J. Pelletier, T. Vanounou, S. Wong, M. Boutros, S. Dumitra, A. Kouyoumdjian, B. Johnston, C. Russell, M. Boutros, S. Demyttenaere, R. Garfinkle, J. Abou-Khalil, C. Nessim, J. Stevenson, F. Heredia, A. Almeciga, A. Fletcher, A. Merchan, L. O. Puentes, Quevedo J. Mendoza, G. Bačic, D. Karlovic, D. Kršul, M. Zelic, I. Luksic, M. Mamic, B. Bakmaz, I. Cóza, E. Dijan, Z. Katusic, J. Mihanovic, I. Rakvin, K. Frantzeskou, N. Gouvas, G. Kokkinos, P. Papatheodorou, I. Pozotou, O. Stavrinidou, A. Yiallourou, L. Martinek, M. Skrovina, I. Szubota, J. Žatecký, V. Javurkova, J. Klat, T. Avlund, P. Christensen, J. L. Harbjerg, L. H. Iversen, D. W. Kjaer, H. Kristensen, M. Mekhael, A. L. Ebbehøj, P. Krarup, N. Schlesinger, H. Smith, A. Abdelsamed, A. Y. Azzam, H. Salem, A. Seleim, A. Abdelmajeed, M. Abdou, N. E. Abosamak, Sayed M. Al, F. Ashoush, R. Atta, E. Elazzazy, M. Elhoseiny, M. Elnemr, M. S. Elqasabi, M. E. Elsayedhewalla, I. Elsherbini, E. Essam, M. Eweda, I. Ghallab, E. Hassan, M. Ibrahim, M. Metwalli, M. Mourad, M. S. Qatora, M. Ragab, A. Sabry, H. Saifeldin, Mesbah Mohamed Elkaffas M. Saleh, A. Samih, Abdelaal A. Samir, S. Shehata, K. Shenit, D. Attia, N. Kamal, N. Osman, A. M. Abbas, Elazeem Has Abd, M. M. Abdelkarem, S. Alaa, A. K. Ali, A. Ayman, M. G. Azizeldine, H. Elkhayat, S. Melghazaly, F. A. Monib, M. A. Nageh, M. M. Saad, M. Salah, M. Shahine, E. A. Yousof, A. Youssef, A. Eldaly, M. Elfiky, A. Nabil, G. Amira, I. Sallam, M. Sherief, A. Sherif, A. Abdelrahman, H. Aboulkassem, G. Ghaly, R. Hamdy, A. Morsi, H. Salem, G. Sherif, H. Abdeldayem, Salama I. Abdelkader, M. Balabel, Y. Fayed, A. E. Sherif, D. Bekele, J. H. Kauppila, E. Sarjanoja, O. Helminen, H. Huhta, J. H. Kauppila, C. Beyrne, L. Jouffret, L. Lugans, L. Marie-Macron, E. Chouillard, Simone B. De, J. Bettoni, S. Dakpé, B. Devauchelle, N. Lavagen, S. Testelin, S. Boucher, R. Breheret, A. Gueutier, A. Kahn, J. Kün-Darbois, A. Barrabe, Z. Lakkis, A. Louvrier, S. Manfredelli, P. Mathieu, A. Chebaro, V. Drubay, Amrani M. El, C. Eveno, K. Lecolle, G. Legault, L. Martin, G. Piessen, F. R. Pruvot, S. Truant, P. Zerbib, Q. Ballouhey, B. Barrat, J. Laloze, H. Salle, A. Taibi, J. Usseglio, D. Bergeat, A. Merdrignac, Roy B. Le, L. O. Perotto, A. Scalabre, A. Aimé, A. Ezanno, B. Malgras, P. Bouche, S. Tzedakis, E. Cotte, O. Glehen, V. Kepenekian, J. Lifante, G. Passot, A. D'Urso, E. Felli, D. Mutter, P. Pessaux, B. Seeliger, J. Bardet, R. Berry, G. Boddaert, S. Bonnet, E. Brian, C. Denet, D. Fuks, D. Gossot, M. Grigoroiu, A. Laforest, Y. Levy-Zauberman, C. Louis-Sylvestre, A. Moumen, G. Pourcher, A. Seguin-Givelet, E. Tribillon, E. Duchalais, F. Espitalier, C. Ferron, O. Malard, U. Bork, M. Distler, J. Fritzmann, J. Kirchberg, C. Praetorius, C. Riediger, J. Weitz, T. Welsch, P. Wimberger, K. Beyer, C. Kamphues, J. Lauscher, F. N. Loch, C. Schineis, M. Albertsmeier, M. Angele, A. Kappenberger, H. Niess, T. Schiergens, J. Werner, R. Becker, J. Jonescheit, I. Pergolini, D. Reim, C. Boeker, I. Hakami, J. Mall, P. Liokatis, W. Smolka, K. Nowak, T. Reinhard, F. Hölzle, A. Modabber, P. Winnand, M. Knitschke, P. Kauffmann, S. Wolfer, J. Kleeff, K. Lorenz, C. Michalski, U. Ronellenfitsch, R. Schneider, E. Bertolani, A. Königsrainer, M. W. Löffler, M. Quante, C. Steidle, L. Überrück, C. Yurttas, C. S. Betz, J. Bewarder, A. Böttcher, S. Burg, C. Busch, M. Gosau, A. Heuer, J. Izbicki, T. O. Klatte, D. Koenig, N. Moeckelmann, C. Nitschke, M. Priemel, R. Smeets, U. Speth, S. Thole, F. G. Uzunoglu, T. Vollkommer, N. Zeller, M. J. Battista, K. Gillen, A. Hasenburg, S. Krajnak, V. Linz, R. Schwab, K. Angelou, D. Haidopoulos, A. Rodolakis, P. Antonakis, K. Bramis, L. Chardalias, I. Contis, N. Dafnios, D. Dellaportas, G. Fragulidis, A. Gklavas, M. Konstadoulakis, N. Memos, I. Papaconstantinou, A. Polydorou, T. Theodosopoulos, A. Vezakis, M. I. Antonopoulou, D. K. Manatakis, N. Tasis, N. 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Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)

Abstract

Background: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. Methods: This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARSCoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. Results: Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P ¼ 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. Conclusion: Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas.
Original languageEnglish
Pages (from-to)88-96
Number of pages9
JournalBritish Journal of Surgery
Volume108
Issue number1
DOIs
Publication statusPublished - Dec 1 2021

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