CT Scanning of Cardiothoracic Patients preoperatively for COVID-19 in a single centre

Title: CT Scanning of Cardiothoracic Patients preoperatively for COVID-19 in a single centre
Author(s): M O’Dwyer, J Fish, JB McLoughlin, D Doyle, T Ní Dhonnchú
Institution: 1. Department of Cardiothoracic Surgery, Cork University Hospital, Wilton, Cork, Ireland 2. Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
Poster: Click to view poster
Category: COVID-19
Abstract: At the genesis of this pandemic, there was concern that operating on patients infected with COVID-19, asymptomatic or not, would harbour an increased morbidity and mortality(1,2). Additionally, protecting other patients and staff from COVID-19 was paramount for safety. As per guidance from the Society of Cardiothoracic Surgery (SCTS), screening patients for COVID-19 with a CT scan prior to surgery in conjunction with a swab was recommended(3). Our study assessed the impact of CT scanning these patients over a two month period, evaluating findings, upstaging of malignancy or changes to operative planning.

Sixty-six patients underwent cardiothoracic procedures in CUH in April and May 2020. 43% were thoracic operations and 57% were cardiac operations. Mean age of patients was 63.6 years(Range 21-82). All patients had a negative COVID-19 swab within 72 hours of surgery. One patient had a previous diagnosis of COVID-19 prior to undergoing CABG. 100% of patients tested negative on nasopharyngeal swab testing for COVID-19. 13 CT Thoraces were completed in referring hospitals. Fifty-three CT’s were performed, on average 2.4 days(Range 0-19) before surgery. 35.8%(19/53) of CTs were performed outside of normal working hours. No CT revealed COVID-19 in this group. 13% had incidental CT findings which required follow up. No patient had upstaging to their disease. No patient had their surgical strategy changed based on screening scan findings. 3 patients died post-operatively due to complications not related to COVID-19. The total estimated cost of just preoperative CT Thorax scans was €12,720 (€240x66 scans) alone.

This small study, at the outset of an evolving pandemic, demonstrated that CT scanning provided additional reassurance. There was no disparity between laboratory viral screening and radiology screening, suggesting a lack of adjunctive benefit.Since this study, a meta-analysis has been performed by Salameh et al. that concludes CT imaging is sensitive but not specific in detecting COVID-19 and thus must be used in conjunction with clinical history and laboratory results in evaluation of patients with suspected COVID-19(4).

1. Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, Tao Q, Sun Z, Xia L. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 2020 Feb 26:200642.
2.SCTS Current Recommendations Regarding Screening for COVID-19 in Patients undergoing Cardiothoracic Surgery (22nd April 2020)
3.St Batholomew’s Hospital Theatre Standard Operating Protocol for COVID-19 April 2020 https://scts.org/wp-content/uploads/2020/04/St-Bartholomews-Theatre-SOP-for-COVID-19-8th-April-2020.pdf
4. Salameh JP, Leeflang MM, Hooft L, Islam N, McGrath TA, Pol CB, Frank RA, Prager R, Hare SS, Dennie C, Spijker R. Thoracic imaging tests for the diagnosis of COVID-19. Cochrane Database of Systematic Reviews. 2020(9).