A retrospective report on the preoperative mandatory SARS-COV-2 infection screening in a single pediatric center. Is it time to stop testing our patients?

ABSTRACT The novel coronavirus SARS-COV-2 (COVID-19) pandemic dramatically changed the workflow of healthcare professionals around the world. Surgical procedures were withheld and postponed in a scenario of fear and uncertainty. Despite numerous medical institutions having swiftly and widely implemented pre-operative screening protocols, cost-effective studies remain scarce specially when comparing to other mitigation measures such as the donning of masks and social distancing measures. The objective of our study is to report the monthly positivity rates of SARS-COV-2 infection in our service and compare our data with monthly positivity rates reported by the State Health Department. Between April, 2020, to February, 2022, 7,199 patients had the RT-PCR for SARS-COV-2 collected, with 187 (2.59%) testing positive for COVID-19. Most of them (62.1%) were asymptomatic. The most common symptoms were coryza (10.7%), fever (10%), and diarrhea (8.7%). Nonetheless, there were two deaths due to COVID-19 reported in our center. Further studies are necessary to elucidate the impact of pre-operative screening for SARS-COV-2 in asymptomatic patients.

I n early 2020, the routine of surgical centers was highly impacted by the pandemic and, in a scenario of fear and uncertainty, many elective surgeries were postponed or suspended.As of May 2020, studies on patients undergoing surgery with SARS-COV-2 infection already showed a 23.8% increase in mortality and a 53.2% increase in pulmonary complications 1 , and operating room professionals were concerned about the risk of intra-hospital transmission of the virus at a time when vaccines were not yet available 2 .Although many of these series included pediatric patients, we still do not know the impact of COVID-19 on the outcome of pediatric surgical patients.
In light of current data, one could speculate that the risk of complications is lower than in adults, either because of the milder presentation of the disease or by the profile of surgeries, which are often shorter and less invasive 3 .
The institution of preoperative systematic screening protocols for SARS-COV-2 mitigated this situation, by potentially reducing the risk of adverse effects in patients and minimizing occupational exposure in health professionals.In addition, it avoided spending on protective materials in cases of uncertain diagnosis, strengthening hospital quality and safety processes 4 .Although adherence by hospitals in Brazil has been wide, studies regarding its effectiveness and cost-effectiveness remain scarce 5 .In the pediatric population -relatively spared from severe forms of the disease -, the lack of evidence is even more critical.

Scientific comunication A B S T R A C T A B S T R A C T
The novel coronavirus SARS-COV-2 (COVID-19) pandemic dramatically changed the workflow of healthcare professionals around the world.Surgical procedures were withheld and postponed in a scenario of fear and uncertainty.Despite numerous medical institutions having swiftly and widely implemented pre-operative screening protocols, cost-effective studies remain scarce specially when comparing to other mitigation measures such as the donning of masks and social distancing measures.The objective of our study is to report the monthly positivity rates of SARS-COV-2 infection in our service and compare our data with monthly positivity rates reported by the State Health Department.Between April, 2020, to February, 2022, 7,199 patients had the RT-PCR for SARS-COV-2 collected, with 187 (2.59%) testing positive for COVID-19.Most of them (62.1%) were asymptomatic.The most common symptoms were coryza (10.7%), fever (10%), and diarrhea (8.7%).Nonetheless, there were two deaths due to COVID-19 reported in our center.Further studies are necessary to elucidate the impact of pre-operative screening for SARS-COV-2 in asymptomatic patients.During the study period, 7,199 patients underwent preoperative RT-PCR for SARS-COV-2, and 187 (2.59%) cases of COVID-19 were diagnosed, most of which (62.1%) were asymptomatic (Table 1).The comparison of the monthly positivity rate in our service with the general positivity rate in the State of São Paulo can be seen in Figure 1, and the clinical and demographic characteristics of the patients, in Table

R E S U M O R E S U M O
The hospital infection control service, with the aim of reducing the risk of intra-hospital transmission of COVID-19, has established the mandatory use of N95/ PFF2 masks for all employees since April 2020.In addition, it has established epidemiological and symptoms screening, with application of a structured questionnaire in the pre-anesthetic evaluation, and collection of RT-P-CR for SARS-COV-2 up to 72 hours before the procedu-1 -Hospital Infantil Sabará, Anestesiologia -São Paulo -SP -Brasil 2 -Hospital Infantil Sabará, Centro de Controle e Infecção Hospitalar -São Paulo -SP -Brasil

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COVID-19 Testing.Perioperative Period.Anesthesia.General Surgery.Rev Col Bras Cir 49:e20223433 re.Elective cases with positive RT-PCR were postponed for at least 15 days from the examination date.In face of moderate to severe clinical conditions, or in immunosuppressed patients, surgery was postponed for at least 20 days.Children with negative RT-PCR, with mild respiratory or flu symptoms, could be operated on after symptoms improvement if the exam had taken place 24 hours after symptoms onset.RT-PCR for SARS-COV-2 has been collected systematically since April 2020.Therefore, the objective of the present study is to describe the positivity rates in one of the largest private pediatric hospital centers in Brazil and, due to the ubiquity of the spread of SARS-COV-2 during the pandemic period, compare them with the general positivity rates of the population of the State of São Paulo, from April 2020 to February 2022, available on a freely accessible digital platform by the State Department of Health 6 .

Figure 1 . 1 . 5 .
Figure 1.Positivity rate in the General population of the State of São Paulo x Surgical patients at the institution.
Note: Categorical variables expressed as proportions and continuous variables as median (IQR 25-75).