HCV screening among surgical patients in a tertiary hospital of Northern China

The diagnosis and treatment rates for hepatitis C virus (HCV) remain below target levels. This study aims to define and analyze the HCV care cascade for surgical patients in a high-prevalence region, evaluate the impact of a hospital-wide elimination program, and identify barriers and facilitators to completing the diagnostic pathway.

This retrospective cohort study analyzed de-identified electronic health records from 114,968 consecutive preoperative patients undergoing routine Hepatitis C virus (HCV) antibody screening at a tertiary academic medical center between January 2021 and December 2024. We evaluated the effectiveness of a multifaceted HCV elimination program initiated in 2022 by assessing patient management through a predefined three-step care cascade: (1) universal anti-HCV antibody screening; (2) HCV RNA testing within 72 h for antibody-positive individuals; and (3) prompt hepatology referral within the patient's hospitalization for RNA-positive cases. Data on patient demographics, clinical department, HCV antibody results, HCV RNA testing completion status, and key clinical variables (emergency surgery, transfusion history, dialysis, length of stay, physician practice duration) were extracted from standardized electronic health records. Data accuracy was verified via a manual audit of 200 randomly selected records. Continuous variables were summarized as mean ± standard deviation (SD) and categorical variables as counts (percentages). Group comparisons were performed using Pearson's χ2 or Fisher's exact tests. A multivariable binary logistic regression model with backward stepwise selection was employed to identify independent predictors of HCV RNA testing completion, and the Hosmer-Lemeshow test was used to assess model goodness-of-fit. Results were reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). A two-tailed P-value < 0.05 was considered statistically significant. A post-hoc power analysis confirmed the study was sufficiently powered (> 80%) for its primary outcomes.

Among 114,968 patients, the overall anti-HCV positivity rate was 2.03% (95% CI: 1.95-2.11; n = 2,334), with significant demographic disparities: males had a 1.48-fold higher positive rate than females (2.45% vs. 1.63%, P < 0.001). The prevalence of hepatitis C antibodies exhibited a nonlinear positive correlation with age distribution, with infection rates rising significantly after the age of 30. The 70-79 age group presented an 11.74-fold greater prevalence than patients aged 40-49 years (3.64% vs. 0.31%, P < 0.001). Significant gaps were observed in the care cascade, with only 33.6% of anti-HCV positive patients completing RNA confirmation. There were notable interdepartmental disparities: Hepatobiliary Surgery had the highest anti-HCV positivity rate (7.90%), whereas Pediatric (0.04%) and Obstetric (0.26%) departments had the lowest. Multivariate logistic regression identified key factors associated with testing completion. A hospital stay of ≤ 7 days was the strongest barrier (aOR = 0.48, 95% CI: 0.39-0.60; P < 0.001). Conversely, receipt of dialysis was the strongest facilitator (aOR = 8.69, 95% CI: 3.83-19.76; P < 0.001), followed by admission to an HCV-related department (aOR = 2.18, 95% CI: 1.75-2.71; P < 0.001) and history of blood transfusion (aOR = 1.82, 95% CI: 1.20-2.76; P = 0.005). Physicians with < 5 years (aOR = 1.60, 95% CI: 1.27-2.01; P < 0.001) or 5-10 years of experience (aOR = 1.71, 95% CI: 1.35-2.18; P < 0.001) were more likely to order testing than those with > 10 years of experience. The model demonstrated good discriminative ability, with an overall correct classification rate of 69.6%.

This study identifies a critical breakdown in the hepatitis C virus (HCV) care cascade at our institution, where a substantial "diagnostic gap" resulted in only 33.63% of anti-HCV positive patients receiving confirmatory RNA testing. The high seroprevalence (2.03%) in our pre-operative cohort, particularly among males and the elderly (peaking at 3.64% in the 70-79 age group), underscores the need for targeted screening. The primary barrier was identified as a fundamental incompatibility between the two-step diagnostic process and clinical workflows, with short hospital stays (≤ 7 days) being the strongest negative predictor. This systemic failure, observed across various non-hepatology departments, contrasts sharply with high performance in settings like Nephrology (87.80% testing rate) and mirrors challenges reported globally. Conversely, downstream linkage to care proved successful, with hepatology referral rates rising to 66.67% in 2024, demonstrating the effectiveness of structured, technology-driven interventions like electronic referral systems. These findings advocate for fundamental system-level reforms, including the implementation of reflex RNA testing, intelligent EMR alert systems, and performance-linked quality metrics, to bridge the diagnostic gap and advance progress towards HCV elimination goals.