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Institutional protocols for coronavirus disease 2019 testing in elective gynecologic surgery across sites for the Society of Gynecologic Surgeons’ Surgical Outcomes during the COVID-19 pandemic (SOCOVID) study

Published:January 21, 2021DOI:https://doi.org/10.1016/j.ajog.2021.01.013

      Objective

      As of January 2021, severe acute respiratory syndrome caused by the novel coronavirus 2 has resulted in over 87 million confirmed cases and 1.9 million deaths worldwide.
      World Health Organization
      WHO coronavirus disease (COVID-19) dashboard.
      In the United States, coronavirus disease 2019 (COVID-19) has overwhelmed healthcare resources and caused suspension of elective surgical care. To better understand the impact of the pandemic on surgical outcomes of women undergoing gynecologic surgeries, the Society of Gynecologic Surgeons (SGS) developed an ongoing multicenter prospective cohort study—Surgical Outcomes during the COVID-19 pandemic (SOCOVID). Despite surgical societies creating recommendations for triage of urgent and emergent gynecologic conditions during the pandemic,
      American College of Surgeons
      COVID-19 guidelines for triage of gynecology patients.
      ,
      Society of Gynecologic Surgeons
      Joint statement on re-introduction of hospital and office-based procedures in the COVID-19 climate for the practicing gynecologist.
      there remains limited guidance surrounding COVID-19 preoperative testing. This study aimed to summarize existing protocols for preoperative COVID-19 testing across SOCOVID-participating institutions to identify patterns and discrepancies.

      Study Design

      Active SGS members from large and geographically diverse teaching institutions in urban settings were approached to participate in the SOCOVID study. A total of 12 institutions joined the research group. Ten institutions received institutional review board approval by the start of the study and were asked to provide preoperative COVID-19 testing protocols, which were deidentified. Descriptive statistics were used to ascertain outcomes of interest, including timing of preoperative COVID-19 tests and management of patients with recently positive test results.

      Results

      Here, 10 institutional protocols were received and reviewed (Table). Furthermore, 8 of the 10 protocols specified the required time frame for obtaining COVID-19 testing (range, 1–5 days) or the expiration time for a given COVID-19 test (range, 3–5 days). In addition, 7 institutions required testing at least 2 days before scheduled surgery to ensure results were available. Management of patients with positive preoperative tests differed among institutions. Nine sites required postponement of surgery for at least 10 days following a positive result (range, 10–30). Two institutions distinguished between the severity of illness, allowing the surgeries of asymptomatic patients to be rescheduled after 14 days and requiring patients with lower respiratory symptoms to postpone elective surgery for at least 30 to 90 days. In addition to postponement of surgery after a positive test result, 3 policies described symptom-based criteria that must be met at the time of rescheduled surgery. These included overall symptom improvement and 24 to 72 hours without fever. Policies regarding repeat COVID-19 testing for patients with previous positive results also varied among institutions. Only 2 of the 9 protocols that addressed this scenario required preoperative COVID-19 testing before rescheduled surgery. These institutions mandated that repeat testing be performed at least 21 days from first positive results. Of the remaining 7 institutions that did not require retesting, 5 stipulated that testing should only be repeated if more than 60 to 90 days had elapsed since the first positive test result.
      TableSummary of preoperative COVID-19 testing protocols for elective gynecologic surgeries across 10 institutions participating in the Society of Gynecologic Surgeons’ SOCOVID study
      Testing parameterInstitution (region)Range
      A (west)B (west)C (midwest)D (midwest)E (south)F (south)G (northeast)H (northeast)I (northeast)J (northeast)
      Timing of preoperative test1–3 d2–3 d2–3 d2–5 d2–5 d1–5 d
      Length of test validity3 d4 d3 d4 d3 d5 d5 d5 d3–5 d
      Minimum length of time to postpone surgery for positive test result10 d, up to 30 d14 d, up to 3 mo if hospitalized
      This institution specified that previously hospitalized patients should have a chest radiograph, serum creatinine, and electrocardiogram obtained within 2 weeks of elective surgery
      10 d28 d14 d, 30 d if pneumonia10 d28 d30 d14 d10–30 d
      Symptom-based criteria to be met at time of rescheduled surgery3 d afebrile, improved symptoms1 d afebrile, improved symptoms3 d afebrile1–3 d afebrile
      Requirement to repeat COVID-19 test after positive test resultNo if <3 moNo if <3 moNoNoNo if <2 dNo if <3 moNo if <3 moYes >21 d
      These institutions required repeat testing be performed before rescheduled surgery for patients with a history of previous COVID-19 positive test result and mandated that this be performed at least 21 days from initial positive test result.
      Yes >21 d
      These institutions required repeat testing be performed before rescheduled surgery for patients with a history of previous COVID-19 positive test result and mandated that this be performed at least 21 days from initial positive test result.
      Date of most recent protocol updateApril 2020Sept. 2020Sept. 2020July 2020Oct. 2020UnknownSept. 2020July 2020Oct. 2020July 2020
      The em dash denotes that a specific parameter was not specified by a particular institutional protocol or could not be calculated.
      COVID-19, coronavirus disease 2019; SOCOVID, Surgical Outcomes during the COVID-19 pandemic.
      Orlando. Institutional protocols for coronavirus disease 2019 in elective gynecologic surgery. Am J Obstet Gynecol 2021.
      a This institution specified that previously hospitalized patients should have a chest radiograph, serum creatinine, and electrocardiogram obtained within 2 weeks of elective surgery
      b These institutions required repeat testing be performed before rescheduled surgery for patients with a history of previous COVID-19 positive test result and mandated that this be performed at least 21 days from initial positive test result.

      Conclusion

      We have presented summary data describing the preoperative COVID-19 testing protocols for elective surgery at 10 US institutions. These policies required universal preoperative COVID-19 testing 1 to 5 days before surgery, and all institutions postponed elective surgery in patients who tested positive for the novel coronavirus 2. Major differences were found in the need for and timing of repeat COVID-19 testing following a positive result. Repeat COVID testing has potential benefits, including reducing nosocomial transmission or operative complications. However, obtaining persistently positive test results in the absence of symptoms or infective viral shedding may delay needed surgeries and lead to complications from the underlying disease. We hope that the ongoing SOCOVID study and other research endeavors may provide greater insights to assist with the development of consistent and evidence-based testing protocols.

      Acknowledgments

      The authors would like to thank SGS and the following individuals involved in the SOCOVID study who contributed institutional protocols: Cheryl Iglesia and Dana Lewis from Medstar Washington Medical Center; Joseph Schaffer and Adam Hare from the University of Texas Southwestern Medical Center; Megan Wasson and Johnny Yi from Mayo Clinic in Phoenix, Arizona; Hye-Chun Hur and Sierra Seaman from Columbia University Irving Medical Center; Gina Northington and Nina Metcalfe from Emory Healthcare; Michael Heit and Jennifer Hamner from Indiana University; Andrew Walter from Kaiser Permanente Medical Center in Roseville, California; Charles Ascher-Walsh and Kelsey Kossl from Mount Sinai Medical Center; and Miles Murphy from the Institute for Female Pelvic Medicine.

      References

        • World Health Organization
        WHO coronavirus disease (COVID-19) dashboard.
        (Available at:)
        https://covid19.who.int/
        Date: 2021
        Date accessed: January 9, 2020
        • American College of Surgeons
        COVID-19 guidelines for triage of gynecology patients.
        (Available at:)
        • Society of Gynecologic Surgeons
        Joint statement on re-introduction of hospital and office-based procedures in the COVID-19 climate for the practicing gynecologist.
        (Available at:)