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.