Preoperative Shielding and N/T RT-PCR Swabbing for Elective Cancer Surgery

1. Background:

The optimal method of screening patients for COVID infection before elective cancer
surgery is unclear. Provisional data from the international COVIDsurg audit as well as a
similar study from China has shown mortality rates of in excess of 20% for COVID +ve
patients undergoing surgery and so ensuring patients do not have infection before
surgery is critical (1).

Current practice for the preoperative screening of elective surgical patients involves a
period of self-isolation, assessment of self-reported symptoms and nose and throat swab
testing. Many patients are asymptomatic with COVID and the false negative rate of RT-PCR
nose and throat swabs may be as high as 30% (2,3). Furthermore, we do not know how
effective our strategy is at preventing hospital acquired COVID in the days after
surgery. Patients are currently going to designated clean (silver) wards postoperatively
to reduce this risk with other patient who have tested negatively to the above screening
process too

2. Rationale:

The aim of this study is to assess the rate of perioperative COVID in elective surgical
patients, and to assess whether RT-PCR swabbing adds any additional value i.e. does it detect
clinically important asymptomatic patients.

If asymptomatic patients are diagnosed preoperatively this will reduce perioperative
morbidity and mortality as well as confirming this as an appropriate preoperative screening
process. Alternatively, should nose and throat swabbing not improve the diagnosis of COVID-19
in asymptomatic patients this trial may stop unnecessary visit to the hospital where they may
be more likely to contract COVID-19 and reduce the use of a limited resource.