Resuming elective surgery amid shortages of rapid severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests and personal protective equipment, while protecting patient and staff safety, posed a challenge at the study institution. Many hospital systems implemented testing of all presurgical patients, using results from tests performed 3 or more days prior to surgery. Among asymptomatic persons, the percent positive rates of coronavirus disease 2019 (COVID-19) tests in the region did not appear to justify this practice. Instead of universal preoperative COVID-19 testing, the authors elected to mitigate risk by implementing a preoperative program including 14 days of recommended patient self-quarantine and social distancing. For those unable to complete this program and for those undergoing high-risk, aerosol-generating procedures, targeted rapid polymerase chain reaction testing within 2 days of surgery was performed. Data from the initial 4 months suggests that this approach was noninferior to universal preoperative testing with regard to postoperative COVID-19 detection and patient exposure-related COVID-19 cases among hospital staff.
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