Routine screening for hepatitis C viral infection in patients undergoing elective cranial neurosurgery

Restricted access

OBJECTIVE

Undiagnosed hepatitis C virus (HCV) and HIV in patients present risks of transmission of bloodborne infections to surgeons intraoperatively. Presurgical screening has been suggested as a protocol to protect surgical staff from these pathogens. The authors sought to determine the incidence of HCV and HIV infection in elective craniotomy patients and analyze the cost-effectiveness of universal and risk factor–specific screening for protection of the surgical staff.

METHODS

All patients undergoing elective craniotomy between July 2009 and July 2016 at the National Brain Aneurysm Center who did not refuse screening were included in this study. The authors utilized rapid HCV and HIV tests to screen patients prior to elective surgery, and for each patient who tested positive using the rapid HCV or HIV test, qualitative nucleic acid testing was used to confirm active viral load, and risk factor information was collected. Patients scheduled for nonurgent surgery who were found to be HCV positive were referred to a hepatologist for preoperative treatment. The authors compared risk factors between patients who tested positive on rapid tests, patients with active viral loads, and a random sample of patients who tested negative. The authors also tracked the clinical and material costs of HCV and HIV rapid test screening per patient for cost-effectiveness analysis and calculated the cost per positive result of screening all patients and of screening based on all patient risk factors that differed significantly between patients with and those without positive HCV test results.

RESULTS

The study population of patients scheduled for elective craniotomy included 1461 patients, of whom 22 (1.5%) refused the screening. Of the 1439 patients screened, 15 (1.0%) tested positive for HCV using rapid HCV screening; 9 (60%) of these patients had active viral loads. No patient (0%) tested positive for HIV. Seven (77.8%) of the 9 patients with active viral loads underwent treatment with a hepatologist and were referred back for surgery 3–6 months after sustained virologic response to treatment, but the remaining 2 patients (22.2%) required urgent surgery. Of the 9 patients with active viral loads, 1 patient (11%) had a history of both intravenous drug abuse and tattoos. Two of the 9 patients (22%) had tattoos, and 3 (33%) were born within the age-screening bracket (born 1945–1965) recommended by the Centers for Disease Control and Prevention. Rates of smoking differed significantly (p < 0.001) between patients who had active viral loads of HCV and patients who were HCV negative, and rates of smoking (p < 0.001) and IV drug abuse (p < 0.01) differed significantly between patients who were HCV rapid-test positive and those who were HCV negative. Total screening costs (95% CI) per positive result were $3,877.33 ($2,348.05–$11,119.28) for all patients undergoing HCV rapid screening, $226.29 ($93.54–$312.68) for patients with a history of smoking, and $72.00 ($29.15–$619.39) for patients with a history of IV drug abuse.

CONCLUSIONS

The rate of undiagnosed HCV infection in this patient population was commensurate with national levels. While the cost of universal screening was considerable, screening patients based on a history of smoking or IV drug abuse would likely reduce costs per positive result greatly and potentially provide cost-effective identification and treatment of HCV patients and surgical staff protection. HIV screening found no infected patients and was not cost-effective.

ABBREVIATIONS CDC = Centers for Disease Control and Prevention; HBV = hepatitis B virus; HCV = hepatitis C virus; IV = intravenous; SVR = sustained virologic response.

Article Information

Correspondence Eric S. Nussbaum: National Brain Aneurysm Center, Minneapolis, MN. lnussbaum@comcast.net.

Disclosures Kevin Kallmes works for and owns equity in Superior Medical Experts.

INCLUDE WHEN CITING Published online September 14, 2018; DOI: 10.3171/2018.4.JNS172475.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Histogram of patient characteristics between patients who tested positive for HCV (Hep+) on the initial rapid test (n = 15), Hep+ patients who had an active viral load on a subsequent qualitative HCV test (n = 9), and patients who were HCV-negative (Hep−) (n = 250). Error bars represent 95% CIs; differences in risk factors between groups were statistically significant (p < 0.05) for the following: history of smoking, between Hep+ (active viral load) and Hep−; history of smoking or IV drug abuse, between Hep+ (on rapid test) and Hep−.

References

  • 1

    AASLD/IDSA HCV Guidance Panel: Hepatitis C guidance: AASLD-IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus. Hepatology 62:9329542015

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Ahmed RBhattacharya S: Universal screening versus universal precautions in the context of preoperative screening for HIV, HBV, HCV in India. Indian J Med Microbiol 31:2192252013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Arts EJHazuda DJ: HIV-1 antiretroviral drug therapy. Cold Spring Harb Perspect Med 2:a0071612012

  • 4

    Asthana SKneteman N: Operating on a patient with hepatitis C. Can J Surg 52:3373422009

  • 5

    DelSole EMMercuri JJStachel APhillips MSZuckerman JD: Risk of hepatitis C virus exposure in orthopedic surgery: is universal screening needed? Am J Orthop 43:E117E1232014

    • Search Google Scholar
    • Export Citation
  • 6

    Denniston MMJiles RBDrobeniuc JKlevens RMWard JWMcQuillan GM: Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010. Ann Intern Med 160:2933002014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Division of Viral Hepatitis: Viral Hepatitis: Testing Recommendations. Atlanta, GA: Centers for Disease Control & Prevention2015

    • Export Citation
  • 8

    Ergünay KŞener BAlp AKarakaya JHasçelik G: Utility of a commercial quantitative hepatitis C virus core antigen assay in a diagnostic laboratory setting. Diagn Microbiol Infect Dis 70:4864912011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Fisher WD: Hepatitis C and the surgeon. Can J Surg 56:80812013

  • 10

    Gańczak MSzych Z: Infections with HBV, HCV and HIV in patients admitted to the neurosurgical department of a teaching hospital. Neurol Neurochir Pol 42:2312372008

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Honeycutt AAHarris JLKhavjou OBuffington JJones TSRein DB: The costs and impacts of testing for hepatitis C virus antibody in public STD clinics. Public Health Rep 122 (Suppl 2):55622007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Jamal AKing BANeff LJWhitmill JBabb SDGraffunder CM: Current cigarette smoking among adults—United States, 2005–2015. MMWR Morb Mortal Wkly Rep 65:120512112016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Jun ZZhen CQuiuLi ZYuanQi ACasado VVFan Y: Screening for human immunodeficiency virus, hepatitis B virus, hepatitis C Virus, and Treponema pallidum by blood testing using a Bio-Flash technology-based algorithm before gastrointestinal endoscopy. J Clin Microbiol 54:300030062016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Kelen GDGreen GBPurcell RHChan DWQaqish BFSivertson KT: Hepatitis B and hepatitis C in emergency department patients. N Engl J Med 326:139914041992

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Kim AYOnofrey SChurch DR: An epidemiologic update on hepatitis C infection in persons living with or at risk of HIV infection. J Infect Dis 207 (Suppl 1):S1S62013

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Kohli AShaffer ASherman AKottilil S: Treatment of hepatitis C: a systematic review. JAMA 312:6316402014

  • 17

    Liddicoat RVHorton NJUrban RMaier EChristiansen DSamet JH: Assessing missed opportunities for HIV testing in medical settings. J Gen Intern Med 19:3493562004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Luzzati RZatta MPavan NSerafin MMaurel CTrombetta C: Prevalence of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infections among transgender persons referred to an Italian center for total sex reassignment surgery. Sex Transm Dis 43:4074112016

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Moore RD: Epidemiology of HIV infection in the United States: implications for linkage to care. Clin Infect Dis 52 (2 Suppl 2):S208S2132011

  • 20

    Rizza SAMacGowan RJPurcell DWBranson BMTemesgen Z: HIV screening in the health care setting: status, barriers, and potential solutions. Mayo Clin Proc 87:9159242012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Spach DH: HCV epidemiology in the United States. Hepatitis C Online. (https://www.hepatitisc.uw.edu/go/screening-diagnosis/epidemiology-us/core-concept/all) [Accessed May 24 2018]

    • Search Google Scholar
    • Export Citation
  • 22

    Tahir MACheema ATareen S: Frequency of hepatitis-B and C in patients undergoing cataract surgery in a tertiary care centre. Pak J Med Sci 31:8958982015

    • Search Google Scholar
    • Export Citation
  • 23

    Tillmann HL: Hepatitis C virus core antigen testing: role in diagnosis, disease monitoring and treatment. World J Gastroenterol 20:670167062014

  • 24

    Tokars JIBell DMCulver DHMarcus RMendelson MHSloan EP: Percutaneous injuries during surgical procedures. JAMA 267:289929041992

  • 25

    Villani CConte SChiozzi FIandolo CPersiani P: Prevalence of hepatitis B and hepatitis C in an orthopaedics and traumatology ward. Chir Organi Mov 86:1671732001

    • Search Google Scholar
    • Export Citation
  • 26

    Wallis GCKim WYChaudhary BRHenderson JJ: Perceptions of orthopaedic surgeons regarding hepatitis C viral transmission: a questionnaire survey. Ann R Coll Surg Engl 89:2762802007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Weber PEberle JBogner JRSchrimpf FJansson VHuber-Wagner S: Is there a benefit to a routine preoperative screening of infectivity for HIV, hepatitis B and C virus before elective orthopaedic operations? Infection 41:4794832013

    • Crossref
    • Search Google Scholar
    • Export Citation

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 53 53 53
Full Text Views 21 21 21
PDF Downloads 40 40 40
EPUB Downloads 0 0 0

PubMed

Google Scholar