| Summary: | <p><strong>Introduction:</strong> Surgical services are preparing to scale-up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery.</p>
<p><strong>Methods:</strong> International cohort study including adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020 (NCT04384926). Patients suspected of SARS-CoV-2 infection preoperatively were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models.</p>
<p><strong>Results:</strong> Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2%) underwent preoperative testing: 1458 (16.6%) had a swab test, 521 (5.9%) CT only, and 324 (3.7%) swab and CT. Pulmonary complications occurred in 3.9% while SARS-CoV-2 infection was confirmed in 2.6%. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95% confidence interval 0.68-0.98, p=0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate but not before minor surgery or in low risk areas. To prevent one pulmonary complication in major or minor surgery the respective number needed to swab test was 18 and 48 in high, and 73 and 387 in low risk areas.</p>
<p><strong>Discussion:</strong> Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low risk areas.</p>
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