ABSTRACT
Background In Response To The Covid-19 Pandemic And National Professional Gastroenterology Society Guidelines, Ucla Health Implemented System-Wide Policies For Safe Non-Urgent Endoscopy On 4/13/2020. These Policies Included Mandatory Nasopharyngeal Covid-19 Testing 48 Hours Prior To All Outpatient Procedures. We Aimed To Determine The Covid-19 Positive Rate Among Outpatients Presenting For Elective Gastrointestinal (Gi) Procedures And To Characterize Patients Who Tested Positive For Covid-19. Methods Ucla Health Is A Large, Integrated Healthcare System With 5 Outpatient Endoscopy Units Across Southern California. Our Study Cohort Included All Patients Scheduled For One Or More Outpatient Procedures (Colonoscopy, Egd, Sigmoidoscopy, Manometry, Ph Study, Small Bowel Enteroscopy, Manometry, Eus, Ercp) Who Underwent Pre-Procedure Covid-19 Testing From 4/13/2020 To 11/5/2020. We Developed An Electronic Dashboard To Track Procedure Date, Type, And Completion Status, Pre-Procedure Covid-19 Test Results 48 Hours Prior To Procedure, And Post-Procedure Covid-19 Test Results Up To 14 Days After A Procedure. We Queried The Electronic Health Record For Patient Data, Performed Manual Chart Review To Identify Covid-19 Symptoms, And Used Administrative Data To Determine Covid-19 Exposures To Gastroenterology Providers And Staff. Our Primary Outcome Was The Preprocedure Covid-19 Positive Rate. We Also Determined Covid-19 Symptom Prevalence And Cases Of New Covid-19 Positivity Post-Procedure. We Used Univariate And Multivariable Logistic Regression To Determine Factors Associated With A Positive Pre-Procedure Covid-19 Test, Controlling For Age, Sex, Race/Ethnicity, And Bmi. Results The Study Cohort Included 9,645 Patients, Representing 10,056 Total Outpatient Scheduled Gi Procedures (Table 1). The Cumulative Pre-Procedure Positive Rate Was 0.3% (N=28), And The Inconclusive Rate Was <0.1% (N=7, Figure 1). One Patient Had A New Positive Covid-19 Result Post-Procedure (Day 4), Associated With New Cough. There Were No Known Covid-19 Exposures Among Gastroenterology Faculty And Staff. Of Patients With A Preprocedure Positive Covid-19 Result, 13 (46.4%) Were Asymptomatic And 10 (35.7%) Had Symptoms Possibly Consistent With Covid-19 (25% Cough, 14.3% Fevers/Chills, 7.1% Diarrhea, 3.6% Myalgias, 3.6% Dyspnea). No Factors Were Significantly Associated With A Positive Pre-Procedure Covid-19 Result In The Multivariable Model. The Covid-19 Testing Positivity Rate Was 3-13% In Los Angeles County During The Study Period. Discussion Implementation Of Mandatory Covid-19 Testing Before Outpatient Gi Procedures Was Successful, And The Positive Rate Was Low. Common Symptoms Among Patients With A Positive Pre-Procedure Covid-19 Result Were Cough, Fevers, And Chills. Although They Were Not Mandated, Post-Procedure Positive Covid-19 Results Were Rare (Table Presented) Patient Characteristics Overall And By Pre-Procedure Covid-19 Test Result (Figure Presented) Pre-Procedure Covid-19 Testing By Result (Per Month And Overall).