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The theoretical mortality risk of an asymptomatic patient with a negative SARS-CoV-2 test developing COVID-19 following elective orthopaedic surgery.
Kader, Nardeen; Clement, Nick D; Patel, Vipul R; Caplan, Nick; Banaszkiewicz, Paul; Kader, Deiary.
  • Kader N; South West London Elective Orthopaedic Centre, Epsom, UK.
  • Clement ND; South West London Elective Orthopaedic Centre, Epsom, UK.
  • Patel VR; Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
  • Caplan N; South West London Elective Orthopaedic Centre, Epsom, UK.
  • Banaszkiewicz P; Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK.
  • Kader D; Queen Elizabeth Hospital Gateshead, Gateshead, UK.
Bone Joint J ; 102-B(9): 1256-1260, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-844475
ABSTRACT

AIMS:

The risk to patients and healthcare workers of resuming elective orthopaedic surgery following the peak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been difficult to quantify. This has prompted governing bodies to adopt a cautious approach that may be impractical and financially unsustainable. The lack of evidence has made it impossible for surgeons to give patients an informed perspective of the consequences of elective surgery in the presence of SARS-CoV-2. This study aims to determine, for the UK population, the probability of a patient being admitted with an undetected SARS-CoV-2 infection and their resulting risk of death; taking into consideration the current disease prevalence, reverse transcription-polymerase chain reaction (RT-PCR) testing, and preassessment pathway.

METHODS:

The probability of SARS-CoV-2 infection with a false negative test was calculated using a lower-end RT-PCR sensitivity of 71%, specificity of 95%, and the UK disease prevalence of 0.24% reported in May 2020. Subsequently, a case fatality rate of 20.5% was applied as a worst-case scenario.

RESULTS:

The probability of SARS-CoV-2 infection with a false negative preoperative test was 0.07% (around 1 in 1,400). The risk of a patient with an undetected infection being admitted for surgery and subsequently dying from the coronavirus disease 2019 (COVID-19) is estimated at approximately 1 in 7,000. However, if an estimate of the current global infection fatality rate (1.04%) is applied, the risk of death would be around 1 in 140,000, at most. This calculation does not take into account the risk of nosocomial infection. Conversely, it does not factor in that patients will also be clinically assessed and asked to self-isolate prior to surgery.

CONCLUSION:

Our estimation suggests that the risk of patients being inadvertently admitted with an undetected SARS-CoV-2 infection for elective orthopaedic surgery is relatively low. Accordingly, the risk of death following elective orthopaedic surgery is low, even when applying the worst-case fatality rate. Cite this article Bone Joint J 2020;102-B(9)1256-1260.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Postoperative Complications / Cause of Death / Elective Surgical Procedures / Coronavirus Infections / Asymptomatic Diseases / Pandemics Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Female / Humans / Male Country/Region as subject: Europa Language: English Journal: Bone Joint J Year: 2020 Document Type: Article Affiliation country: 0301-620X.102B9.BJJ-2020-1147.R1

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Postoperative Complications / Cause of Death / Elective Surgical Procedures / Coronavirus Infections / Asymptomatic Diseases / Pandemics Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Female / Humans / Male Country/Region as subject: Europa Language: English Journal: Bone Joint J Year: 2020 Document Type: Article Affiliation country: 0301-620X.102B9.BJJ-2020-1147.R1