P2502 - Positive Pre-Procedure COVID-19 Rates Trend Downward as Community Vaccination Rates Rise

Tuesday, October 26, 2021

10:30 AM – 4:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Camille Soroudi, MD

David Geffen School of Medicine at UCLA
Los Angeles, CA, United States

Camille Soroudi, MD¹, Artin Galoosian, MD, MA¹, Bao Sean Nguyen, MD¹, Natalia Penaloza, BS¹, Liu Yang, MD, MPH¹, Michael Rofail, BS¹, Connolly Lynn, MD¹, Kevin Ghassemi, MD¹, Eric Esrailian, MD, MPH¹, Folasade May, MD, PhD²
¹David Geffen School of Medicine at UCLA, Los Angeles, CA; ²University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA

Introduction: In response to the COVID-19 pandemic and national guidelines, UCLA Health implemented system-wide policies for resuming safe non-urgent endoscopy on 4/13/2020. These policies included mandatory COVID-19 testing 48 hours prior to all outpatient procedures. In light of declining COVID-19 cases and increasing vaccination rates in the surrounding community in early 2021, we aimed to determine the COVID-19 positive rate among outpatients presenting for elective endoscopy.

Methods: UCLA health is a large, integrated health system with 5 outpatient endoscopy units. Our study cohort included all patients scheduled for ≥ 1 outpatient procedures (colonoscopy, EGD, sigmoidoscopy, manometry, pH study, small bowel enteroscopy, manometry, EUS, ERCP) who underwent pre-procedure COVID-19 testing between 4/13/2020 and 4/22/2021. We queried the electronic health record for patient data (age, sex, race/ethnicity), procedure date & type, and COVID-19 test results 48 hours prior to procedure. Our primary outcome was the pre-procedure COVID-19 positive test rate. We compared this rate to the Los Angeles (LA) County COVID-positive test rate and LA county vaccination rates over the same period. We assessed overall COVID-positive test rate by patient demographic characteristics and used univariate and multivariable logistic regression to determine factors associated with a positive test, controlling for age, sex, and race/ethnicity.

Results: The study cohort included 17,278 patients, representing 18,533 total scheduled outpatient procedures (Table 1). The cumulative pre-procedure COVID-19 positive test rate in the study cohort was 0.43% (n=79) and the inconclusive rate was 0.11% (n=21). For LA County, the COVID-19 positive test rate was 1.1-15.4% and the vaccination was 1.0-57.7% during the study period (Figure 1). Hispanic race/ethnicity was significantly associated with a positive pre-procedure COVID-19 test result after adjusting for age and sex (adjusted OR: 3.22, 95% CI: 1.82-5.69).

Discussion: The positive test rate in a mandatory pre-procedure COVID-19 testing program was overall low, even during months of high community prevalence. Notably, the monthly COVID-positive rate in our cohort paralleled monthly trends in the surrounding community, and both declined as COVID-19 vaccination rates steadily increased after December 2020. Our results support new guidance to stop routine COVID-19 testing prior to endoscopy given low overall prevalence and risk of transmission.

Figure: Figure 1. Trends in UCLA Health COVID-19 positive test rate (red), Los Angeles County COVID-19 positive test rate (blue), and Los Angeles County COVID-19 vaccination rate (green) during the study period.

Patient characteristics	All cases, N=18,533 N (%)	Negative COVID-19 pre-procedure test result, n_a=18,433 n (%)	Positive COVID-19 pre-procedure test result, n_b=79 n (%)	Inconclusive COVID-19 pre-procedure test result, n_c=21 n (%)	P-value^	Adjusted Odds Ratio (95% CI)^£
Age (mean ± SD)	55.4 ± 14.6	55.4 ± 14.6	52.3 ± 14.5	56.8 ± 11.7	p=0.16	0.99 (0.97, 1.00)
Gender (N, %)
Male	9932 (53.6%)	8557 (46.4%)	36 (45.6%)	8 (38.1%)	p=0.74	REF
Female	8601 (46.4%)	9876 (53.6%)	43 (54.4%)	13 (61.9%)		0.97 (0.60, 1.56)
Race/Ethnicity (N, %)*
Hispanic	2292 (14.0%)	2265 (13.9%)	23 (32.4%)	4 (23.5%)	p< 0.01	3.22 (1.82, 5.69)
Non-Hispanic White	10181 (62.2%)	10142 (62.3%)	32 (45.1%)	7 (41.2%)		REF
Non-Hispanic Asian	1582 (9.7%)	1577 (9.7%)	2 (2.8%)	3 17.7%)		0.43 (0.10, 1.81)
Non-Hispanic Black	1121 (6.9%)	1114 (6.9%)	6 (8.5%)	1 (5.9%)		1.81 (0.75, 4.38)
Non-Hispanic Other	1184 (7.2%)	1174 (7.2%)	8 (11.3%)	2 (11.8%)		1.95 (0.89, 4.29)

Table: Table 1. Patient Characteristics and Adjusted Analysis Results.
* 2173 cases with missing or unknown race/ethnicity
^ P-value was obtained from tests comparing the demographic characteristics among patients with negative, inconclusive, and positive results using chi-square or student’s t-test.
£ Odds ratios were adjusted odds ratios derived from multivariable logistic regression model that included age, gender, and race/ethnicity.

Disclosures:

Camille Soroudi indicated no relevant financial relationships.

Artin Galoosian indicated no relevant financial relationships.

Bao Sean Nguyen indicated no relevant financial relationships.

Natalia Penaloza indicated no relevant financial relationships.

Liu Yang indicated no relevant financial relationships.

Michael Rofail indicated no relevant financial relationships.

Connolly Lynn indicated no relevant financial relationships.

Kevin Ghassemi indicated no relevant financial relationships.

Eric Esrailian indicated no relevant financial relationships.

Folasade May indicated no relevant financial relationships.

Camille Soroudi, MD¹, Artin Galoosian, MD, MA¹, Bao Sean Nguyen, MD¹, Natalia Penaloza, BS¹, Liu Yang, MD, MPH¹, Michael Rofail, BS¹, Connolly Lynn, MD¹, Kevin Ghassemi, MD¹, Eric Esrailian, MD, MPH¹, Folasade May, MD, PhD². P2502 - Positive Pre-Procedure COVID-19 Rates Trend Downward as Community Vaccination Rates Rise, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.