Objective: Preoperative testing for COVID-19 has become widely established to avoid inadvertent surgery on patients with COVID-19 and prevent hospital outbreaks, however, there is limited evidence underpinning new protocols. We wished to study the effectiveness of preoperative COVID-19 testing during and after the first wave of the pandemic in Ireland. Design Prospective cohort study. Setting: 2 university hospitals in the Republic of Ireland. Participants: Patients undergoing otolaryngology surgery and the otolaryngologists performing surgery. Main outcome measure: Incidence of COVID-19 within 30 days of surgery. Results: 173 patients (56% male) were recruited. 123 (71%) patients “cocooned” for 14 days prior to surgery. All patients completed a questionnaire prior to hospital admission. 156 patients (90%) had reverse transcriptase-polymerase chain reaction (RTPCR) nasopharyngeal swabs, 14 patients (8%) had CT thorax. No cases of COVID-19 were detected among patients followed up at 30 days. Two surgeons developed COVID-19 early during the study period not considered to be related directly to contact within the hospital. Conclusion: Current pre-operative testing protocols consisting primarily of questionnaires and RT-PCR resulted in zero cases of COVID reported in this cohort. It is possible that COVID-19 restrictions and high proportion of patients cocooning preoperatively were factors in ensuring a low rate of COVID-19 postoperatively. Ongoing data collection is required to confirm these findings in the setting of further disease surges.