Comment on: Resuming elective operations after COVID-19 pandemic

Abstract

We read with interest ‘Resuming elective operations after COVID19 pandemic’. National Institute for Health and Care Excellence guidelines recommend strict social distancing for 14 days before the procedure, and self-isolation during the 3 days from a preoperative SARS-CoV-2 test to the date of operation. We report a case of a 76-year-old man admitted for an elective laparoscopic anterior resection for colorectal cancer that had been postponed owing to the pandemic. A preoperative SARSCoV-2 swab was positive, which delayed his operation by a further 14 days before a repeated swab that returned a negative result. The patient remained asymptomatic throughout. Despite an uncomplicated operation, the patient was noted to be persistently febrile with no other symptoms on day 2 after the procedure, at which point a third SARS-CoV-2 swab was performed and was positive. CT of the chest, abdomen, and pelvis showed no evidence of postoperative complications and no signs of COVID-19, but did find a small pulmonary embolism for which the patient was started on anticoagulation. This case highlights the dubious relevance of preoperative SARS-CoV-2 tests. The patient’s second swab may have been a false-negative (estimated rate 30–50 per cent). It is arguable whether his second positive swab had a significant effect on prognosis as the patient was discharged on postoperative day 4 and has recovered well at home. Early studies suggested that 20 per cent of individuals can have a positive COVID-19 result for 1 month after symptom onset. The risk of hospital-acquired COVID-19 remains a possibility in this instance, with estimates as high as 16.2 per cent. As hospitals struggle with the ever-increasing backlog of cases, we are clearly in need of a more robust method of preoperative COVID-19 risk assessment, given the questionable validity of a swab result. The impact on both cancer and non-cancer surgery from delayed return to full capacity is yet to be determined.