Yield of Screening for COVID-19 in Asymptomatic Patients Before Elective or Emergency Surgery Using Chest CT and RT-PCR (SCOUT): Multicenter Study

Puylaert, Carl A. J.; Scheijmans, Jochem C. G.; Borgstein, Alexander B. J.; Andeweg, Caroline S.; Bartels-Rutten, Annemarieke; Beets, Geerard L.; van Berge Henegouwen, Mark I.; Braak, Sicco J.; Couvreur, Roy; Daams, Freek; van Es, Hendrik W.; Franken, Lotte C.; Grotenhuis, Brechtje A.; Hendriks, Eduard R.; de Hingh, Ignace H. J. T.; Hoeijmakers, Fieke; ten Holder, Joris T.; Huisman, Peter M.; Kazemier, Geert; van Kesteren, Floortje; van Kesteren, Jurre; Keywani, Kammy; Kuiper, Sara Z.; Lange, Maurits D. J.; Lobatto, Mark E.; du Mée, Arthur W. F.; Poeze, Martijn; van Praag, Elise M.; van Rossen, Jorit; van Santvoort, Hjalmar C.; Sedee, Wouter J. A.; Seelen, Leonard W. F.; Sharabiany, Sarah; Sosef, Nico L.; Quanjel, Marian J. R.; Veltman, Jeroen; Verhagen, Tim; van de Vlasakker, Vincent C. J.; Weeder, Pepijn D.; van Werven, Jochem R.; Wesdorp, Nina J.; van Dieren, Susan; Han, Alvin X.; Russell, Colin A.; de Jong, Menno D.; Bossuyt, Patrick M. M.; Quarles van Ufford, Jet M. E.; Prokop, Mathias W.; Gisbertz, Suzanne S.; Prins, Jan M.; Besselink, Marc G.; Boermeester, Marja A.; Gietema, Hester A.; Stoker, Jaap

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.