Global study on preoperative testing adds to evidence on safe surgery during the COVID-19 pandemic

Schulich Medicine & Dentistry researcher Janet Martin says new evidence about how to continue with safe surgery during the pandemic has led to the launch of a dedicated toolkit to guide hospitals in keeping elective surgery up and running safely.

A new global study provides further evidence about how to continue with safe surgery during the pandemic, and has also led to the launch of a dedicated toolkit to guide hospitals in keeping elective surgery up and running safely.

The study, published in the British Journal of Surgery, shows routinely testing patients for COVID-19 before major surgery could reduce the risk of respiratory complications and save lives.

Janet Martin, Associate Professor at Schulich Medicine Dentistry, Western University.

Janet Martin, Associate Professor at Western University’s Schulich School of Medicine & Dentistry, is part of the CovidSurg Collaborative which includes researchers working together from around the world. The team found that nasal swab tests to confirm that asymptomatic patients were not infected with SARS-CoV-2 was associated with lower rates of post-operative complications.

Researchers also noted that the main benefit was seen before major surgery and in areas with a higher rate of COVID-19.

Swab testing gave surgeons the opportunity to identify asymptomatic infected patients and postpone their operation, avoiding the severe risk of COVID-19 complications after surgery. Routine testing also helped prevent cross-infection from patients with no symptoms to other elective surgical patients upon admission to hospital.

“In Canada, nasal swab testing is routinely used before surgery in regions where COVID-19 is circulating, though not universally,” Martin said. She added that challenges due to testing turnaround times and supply chain backlogs may contribute to surgical delays. “That said, we now have the evidence required to prioritize testing in regions where COVID-19 incidence is high, and to de-prioritize routine testing in regions where COVID-19 is rare.”

The collaborative also launched  a dedicated ‘toolkit’ that will help hospitals and health care providers around the world get elective surgery up-and-running again, after more than 28 million procedures were postponed in the first phase of the global pandemic.

“To date, most recommendations to guide surgical decisions during the pandemic around the world have largely been opinion-based, given the lack of studies early on,” said Martin. “Now that we have completed a number of studies, we created the Surgical Toolkit to collect the evidence to support evidence-based decisions. The toolkit addresses how to maximize surgical safety and improve outcomes for patients who need surgery during the pandemic, including specific strategies to reduce complications and cancellations.”

Collaborative lead Dr. Aneel Bhangu, from the National Institute for Health ResearchGlobal Health Research Unit on Global Surgery, at the University of Birmingham, commented, “Our findings demonstrate major variation between countries in the application of preoperative testing. Whilst a clear benefit to testing was seen, just one in four patients were screened for infection. This illustrates the need for global expansion and standardization of swab testing worldwide.”

The COVIDSurg toolkit will support individual hospitals, regions, and countries during a major global reorganization of surgical services during the pandemic and beyond, by:

  • Summarizing published data to support safe surgical practice;
  • Guiding effective surgical recovery plans; and
  • Creating a five-year vision of safe and effective surgery that addresses global challenges, including shortfalls in access to surgery that existed before the pandemic.

A copy of the global toolkit can be downloaded at

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