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Routine testing for COVID-19 can make surgery safer

Routine testing patients for COVID-19 before major surgery could reduce the risk of respiratory complications and save lives, an NIHR-funded trial has revealed.

A global team of researchers found using a nasal swab test to confirm that asymptomatic patients were not infected with SARS-CoV-2 was associated with a lower rate of postoperative complications. The main benefit was seen before major surgery and areas with a higher rate of COVID-19.

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

Led by researchers at the University of Birmingham, the COVIDSurg Collaborative comprises of experts from over 130 countries. The group has published its findings in the British Journal of Surgery and is calling for pre-operative swab testing for all patients as part of a broader strategy to continue surgery safely during the pandemic.

The collaborative is backing this call with the launch of a dedicated ‘toolkit’ that will help hospitals and healthcare 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.

Collaborative lead Dr. Aneel Bhangu, from the NIHR Global Health Research Unit on Global Surgery, at the University of Birmingham, said: “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 standardisation of swab testing worldwide.

“Preoperative swab testing should not be considered in isolation, but as part of a broader plan to minimise risks for patients, including setting up COVID-19 free surgical pathways in all hospitals performing elective surgery. For major surgery one serious postoperative complication was avoided for every 17 tests performed. We urge care providers to provide a routine swab test for all patients undergoing elective surgery whether or not they have symptoms.”

Dr. James Glasbey, study lead at the University of Birmingham, said: “Surgery is an essential part of all health systems. On average, you will undergo three to four operations during your lifetime. Surgery remains the cure for most cancers and underpins the treatment of many non-infectious diseases.”

“Our new toolkit will help everyone involved in surgical planning over the next five years, including providers, healthcare leaders, patients, governments, financers and industry. It addresses global challenges, but is locally adaptable to hospitals and environments with varying access to resources.”

A copy of the global toolkit can be downloaded at

The trial was funded by the NIHR’s Global Health Research Unit on Global Surgery.

More information is available on the NIHR Funding & Awards Website.