Preoperative Testing
The issue of preoperative SARS-CoV-2 testing remains a controversial
topic. Given the aerosolizing nature of major head and neck surgery,
risk of transmission to health care providers from asymptomatic patients
is a major concern. Additionally, there is legitimate concern that
operating on a patient in the preclinical incubation period may lead to
worse outcomes with postoperative respiratory
compromise4.
At the University of Pittsburgh, preoperative testing has recently
become available to all of our patients undergoing major head and neck
surgery. We are now making this an essential component of the
preoperative evaluation. Patients that test positive will be postponed
and those that test negative will proceed with surgery. However, given
that our institutional PCR based testing has a quoted false negative
rate of nearly 25%, procedures on negative patients will still be
performed with full PPE and N95 masks. It should be noted that some
institutions are requiring two negative preoperative tests prior to
proceeding with surgery. We have not yet adopted this strategy.
Postoperatively, standard surgical masks are worn by the care team
during non-aerosolizing care.