EP 51 - Safety and Cost Effectiveness of a Non-testing Based COVID Strategy for Pediatric Surgical Patients During the sars-cov-2 Pandemic

Background: Perioperative services faced many challenges during the SARS-CoV-2 (COVID-19) pandemic. Elective surgical cases were initially postponed in accordance with national and local guidelines. As hospitals resumed surgical cases, universal COVID-19 preoperative testing became customary practice but was not always practical for pediatric facilities. Challenges included test availability, laboratory capacity, access to pediatric testing sites and false negative results (antigen or polymerase chain reaction based) if collected during the viral incubation time (2-14 days).

Methods: To combat these challenges, this pediatric hospital adopted a “COVID-19 non-testing-based strategy” in their approach to resuming non-emergent surgical procedures. All perioperative patients were assumed as being COVID-19 positive and appropriate Personal Protective Equipment (PPE) was worn. This included a fit-tested N95 mask, isolation gown, gloves and eye protection for all aerosol generating procedures (AGPs). From April to December of 2020, a retrospective cohort study of 6531 pediatric surgical cases were performed using this non-testing-based strategy. Cost effectiveness was then compared between the strategies of universal preoperative testing versus the additional PPE needed to treat all surgical cases as COVID-19 positive.

Results: With this strategy, exposure and transmission risk was mitigated and allowed surgery cases to resume. No breaches in PPE were identified, requiring no additional follow-up for exposure or lost work hours. PPE shortages could impact this approach. Cost savings of the non-testing-based strategy showed a significant reduction compared to the universal preoperative COVID-19 testing. The total amount saved was approximately 528,000 dollars.

Conclusions: In conclusion, a non-testing-based strategy proved to be an effective strategy for the management of perioperative patients during the COVID-19 pandemic. Such information could be applicable for future pandemic healthcare response.