Early Recognition of Coronavirus 2019 Disease (COVID-19) Infection in Surgical Inpatients: The Importance of a Risk-Stratified Approach for Early Testing and Isolation

In the ongoing coronavirus disease 2019 (COVID-19) pandemic, resuming provision of surgical services poses a challenge given that patients may have acute surgical pathologies with concurrent COVID-19 infection. We utilized a risk-stratified approach to allow for early recognition and isolation of potential COVID-19 infection in surgical patients, ensuring continuity of surgical services during a COVID-19 outbreak. Over a four-month period from January to April 2020, surgical patients admitted with concurrent respiratory symptom, infiltrates on chest imaging, or suspicious travel/epidemiologic history were placed in a dedicated ward in which they were tested for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). If emergency operations were necessary prior to the exclusion of COVID-19, patients were managed as per suspected cases of COVID-19, with appropriate precautions and full personal protective equipment (PPE). From January through April 2020, a total of 8,437 patients were admitted to our surgical department; 5.9% (498/8437) required peri-operative testing for SARS-CoV-2. Because testing was in-house with turnaround within 24 hours, only a small number of emergency operations (n = 10) were conducted for suspected COVID-19 cases prior to results; none tested positive. The testing yield was lower in surgical inpatients compared with medical inpatients (odds ratio [OR] = 0.20, 95% confidence interval [CI], 0.12-0.32, p < 0.001). Three operations were conducted in known COVID-19 cases; all healthcare workers (HCWs) used full PPE. A risk-stratified testing strategy picked up previously unsuspected COVID-19 in six cases; 66.7% (4/6) were asymptomatic at presentation. Although 48 HCWs were exposed to these six cases, delayed diagnosis was averted and no evidence of spread to patients or HCWs was detected. A risk-stratified approach allowed for early recognition, testing, and isolation of potential COVID-19 infection in surgical patients, ensuring continuity of surgical services.