Meta-analysis of COVID-19 prevalence during preoperative COVID-19 screening in asymptomatic patients

Ellen de Bock, Mando D. Filipe, Roger K. J. Simmermacher, A. Christiaan Kroese, Menno R. Vriens, Milan C. Richir

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OBJECTIVES: Patients with COVID-19 may be asymptomatic and are able to transmit COVID-19 during a surgical procedure, resulting in increased pressure on healthcare and reduced control of COVID-19 spread. There remains uncertainty about the implementation of preoperative screening for COVID-19 in asymptomatic surgical patients. Therefore, this study aims to determine the prevalence of preoperative COVID-19, confirmed by reverse transcriptase PCR (RT-PCR), in asymptomatic patients. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Pubmed and Embase databases were searched through 20 February 2022. ELIGIBILITY CRITERIA: All COVID-19 articles including preoperative asymptomatic patients were included. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed risk of bias. Meta-analysis was performed to determine the prevalence of COVID-19 with 95% CI. Moreover, estimated positive predictive value (PPV), negative predictive value, false-positives (FP) and false-negatives were calculated for preoperative asymptomatic patients. RESULTS: Twenty-seven studies containing 27 256 asymptomatic preoperative screened patients were included, of which 431 were positive for COVID-19 by RT-PCR test. In addition, the meta-analysis revealed a pooled COVID-19 prevalence of 0.76% (95% CI 0.36% to 1.59%). The calculated PPV for this prevalence is 40.8%. CONCLUSIONS: The pooled COVID-19 prevalence in asymptomatic patients tested preoperatively was 0.76%, with low corresponding PPV. Consequently, nearly three-quarters of postponed surgical procedures in asymptomatic preoperative patients may be FP. In the event of similar pandemics, modification of preoperative mandatory RT-PCR COVID-19 testing in asymptomatic patients may be considered.
Original languageEnglish
Article numbere058389
Pages (from-to)e058389
JournalBMJ Open
Issue number7
Publication statusPublished - 1 Jul 2022


  • COVID-19
  • infection control
  • surgery

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