Background: 

The long incubation period and asymptomatic spread of COVID-19 present considerable challenges for health-care institutions. The identification of infected individuals is vital to prevent the spread of illness to staff and other patients as well as to identify those who may be at risk for disease-related complications. This is particularly relevant with the resumption of elective orthopaedic surgery around the world. We report the results of a universal testing protocol for COVID-19 in patients undergoing orthopaedic surgery during the coronavirus pandemic and to describe the postoperative course of asymptomatic patients who were positive for COVID-19.

Methods: 

A retrospective review of adult operative cases between March 25, 2020, and April 24, 2020, at an orthopaedic specialty hospital in New York City was performed. Initially, a screening questionnaire consisting of relevant signs and symptoms (e.g., fever, cough, shortness of breath) or exposure dictated the need for nasopharyngeal swab real-time quantitative polymerase chain reaction (RT-PCR) testing for all admitted patients. An institutional policy change occurred on April 5, 2020, that indicated nasopharyngeal swab RT-PCR testing for all orthopaedic admissions. Screening and testing data for COVID-19 as well as relevant imaging, laboratory values, and postoperative complications were reviewed for all patients.

Results: 

From April 5, 2020, to April 24, 2020, 99 patients underwent routine nasopharyngeal swab testing for COVID-19 prior to their planned orthopaedic surgical procedure. Of the 12.1% of patients who tested positive for COVID-19, 58.3% were asymptomatic. Three asymptomatic patients developed postoperative hypoxia, with 2 requiring intubation. The negative predictive value of using the signs and symptoms of disease to predict a negative test result was 91.4% (95% confidence interval [CI], 81.0% to 97.1%). Including a positive chest radiographic finding as a screening criterion did not improve the negative predictive value of screening (92.5% [95% CI, 81.8% to 97.9%]).

Conclusions: 

A protocol for universal testing of all orthopaedic surgery admissions at 1 hospital in New York City during a 3-week period revealed a high rate of COVID-19 infections. Importantly, the majority of these patients were asymptomatic. Using chest radiography did not significantly improve the negative predictive value of screening. These results have important implications as hospitals anticipate the resumption of elective surgical procedures.

Level of Evidence: 

Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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骨科手术中对COVID-19的通用测试表明，无症状感染的比例很高。

背景： 

COVID-19的潜伏期长且无症状传播，这对卫生保健机构构成了巨大挑战。识别感染者对于防止疾病传播到医务人员和其他患者以及识别可能患有疾病相关并发症的人至关重要。这与在世界范围内恢复整形外科手术特别相关。我们报告了在冠状病毒大流行期间进行整形外科手术的患者中，针对COVID-19的通用测试协议的结果，并描述了COVID-19阳性的无症状患者的术后病程。

方法： 

在纽约市一家骨科专科医院对2020年3月25日至2020年4月24日之间的成人手术病例进行了回顾性研究。最初，由相关体征和症状（例如发烧，咳嗽，呼吸急促）或暴露所组成的筛查问卷表明，需要对所有入院患者进行鼻咽拭子实时定量聚合酶链反应（RT-PCR）检测。一项机构政策变更发生在2020年4月5日，表明所有骨科入院患者均进行了鼻咽拭子RT-PCR测试。审查了所有患者的COVID-19筛查和测试数据以及相关的影像学，实验室检查值和术后并发症。

结果： 

从2020年4月5日到2020年4月24日，有99位患者在计划的整形外科手术之前接受了常规鼻咽拭子COVID-19测试。在COVID-19检测呈阳性的12.1％的患者中，无症状的占58.3％。3例无症状患者发生了术后缺氧，其中2例需要插管。使用疾病的体征和症状预测阴性结果的阴性预测值为91.4％（95％置信区间[CI]为81.0％至97.1％）。包括阳性的胸部X线影像学检查作为筛查标准不能改善筛查的阴性预测价值（92.5％[95％CI，81.8％至97.9％]）。

结论： 

在三周内对纽约市一家医院的所有骨科手术入院进行通用测试的协议显示，COVID-19感染率很高。重要的是，这些患者大多数没有症状。使用胸部放射线照相不能显着提高筛查的阴性预测价值。这些结果具有重要意义，因为医院预计将恢复选择性手术程序。

证据级别： 

诊断IV级。有关证据水平的完整说明，请参见《作者说明》。