Pre-Operative Screening
Patients scheduled to undergo head and neck oncological surgery in Wuhan, China were asked to self-isolate for a period of 14 days prior to the operation date. Screening was performed for symptoms of COVID-19 and patients were required to have two negative viral swabs on polymerase chain reaction (PCR) prior to the surgery. At the University of Toronto, varied practices are being used across hospitals, but all are extensively focused on screening for symptoms of COVID-19. Several hospitals are ensuring patients undergoing surgery have at least one negative viral swab (PCR testing) prior to the operation. It must be noted, however, that a risk of transmission remains despite negative testing, as the sensitivity of PCR by viral swab (~70%) is imperfect25-27. Head and neck surgeons must therefore consider the continued use of appropriate PPE despite negative testing. With all operative cases, it is imperative to balance the benefits of surgery against the risks during this pandemic for each individual patient.
Close consideration of baseline functional status and the presence of comorbidities remains important in surgical decision making. Head and neck cancer patients are often male, elderly, and frail28. These considerations increase susceptibility to post-operative complications and are additionally associated with both increased risk of COVID-19 diagnosis and adverse28-31. At the Renmin Hospital of Wuhan University, mortality rates for patients who were unintentionally scheduled for elective surgery during the COVID-19 incubation period exceeded 20%, with 44% requiring intensive care unit admission29. Risks are further amplified as patients with cancer are disproportionately affected by COVID-19, having over two times higher odds of being diagnosed with the infection32, and over five times higher odds of experiencing severe adverse events33.