Objectives The aim of this study was to confirm our clinical impression that a significant number of surgical patients, otherwise presenting without specific COVID-19 complaints, were initially overdiagnosed with COVID-19, leading towards treatment delays and potential harm in cases which require emergency surgery. We wanted to investigate the significance and magnitude of these ‘overdiagnosis’ cases and when possible, quantify the effects with follow up on patients’ two-week morbidity and mortality and length of hospital stay.
Method Patient data was collected from 25 March – 10 April 2020 in three general hospitals in the city of Makassar, Indonesia. The inclusion criteria were patients that were candidates for urgent or emergency surgical operation, without typical COVID-19 complaints but with chest X-rays, blood result or rapid antibody tests that otherwise pointed towards COVID-19 infection. Data was also collected from the involved healthcare providers on the treatment timelines for these patients. These were later matched to later nasopharyngeal swab PCR results on whether these patients actually had confirmed COVID-19 infection, and matched with their length of hospital stay, as well as morbidity and mortality after two weeks, compared to surgical patients during the same period without COVID-19 suspicions.
Results • Data of 6 digestive surgery, 5 neurosurgery & plastic reconstruction, 3 orthopedic surgery and 2 vascular surgery patients were collected. All patients had abnormal chest X-ray findings, 7 patients showed lymphocytosis and increased NLR ratio, and 4 patients had positive total antibody rapid test. • 3 patients were later confirmed with COVID-19 infection • On average patients suffered 5.2 h delay due before they underwent surgery • Patients were 2x more likely to have to undergo transfer to another hospital • On average patients stayed for 2.3 days longer in hospital • 2-week morbidity from this cohort is comparable to the cohort without COVID-19 suspicions • Two neurosurgery patients (one with post-operative hematoma and one with post-operative meningitis) and one digestive surgery patient (from sepsis) died in the first 2 weeks. 1 patient with confirmed COVID-19 infection are now already discharged and two others are still being treated and currently in good condition.
Conclusions Stringent measures in diagnosing all possible COVID-19 infections are necessary to protect healthcare workers and facility, including all other patients. However, lack of accurate testing method that could give rapid results may allow patients to be overdiagnosed with COVID, which may create harm in patients who needed rapid intervention. Our study found that surgical patients that presented with abnormal chest X-ray findings, all categorized as suspected infections, suffered an average of 5.2 hours delay in receiving surgery, were 2x more likely to have to undergo hospital transfers, and stayed 2.3 days longer on average. Morbidity seems comparable to non-suspected patients. 3 cases of post-operative deaths occured in this group. Only 3 patients later had confirmed COVID-19 infection. This highlights the possible indirect harm caused by overdiagnosis during the COVID-19 pandemic, precipitated by stringent needs for safety and the lack of rapid, accurate testing.
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