1
|
Di Maida F, Grosso AA, Lambertini L, Paganelli D, Marzocco A, Salamone V, Bacchiani M, Oriti R, Vittori G, Salvi M, Tuccio A, Mari A, Minervini A. Is it safe to defer prostate cancer treatment? Assessing the impact of surgical delay on the risk of pathological upstaging after robot-assisted radical prostatectomy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108398. [PMID: 38733924 DOI: 10.1016/j.ejso.2024.108398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/28/2024] [Accepted: 05/07/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION We sought to investigate whether surgical delay may be associated with pathological upstaging in patients treated with robot assisted radical prostatectomy (RARP) for localized and locally advanced prostate cancer (PCa). MATERIALS AND METHODS Consecutive firstly-diagnosed PCa patients starting from March 2020 have been enrolled. All the patients were categorized according to EAU risk categories for PCa risk. Uni- and multivariate analysis were fitted to explore clinical and surgical predictors of pathological upstaging to locally advanced disease (pT3/pT4 - pN1 disease). RESULTS Overall 2017 patients entered the study. Median age at surgery was 68 (IQR 63-73) years. Overall low risk, intermediate risk, localized high risk and locally advanced disease were recorded in 368 (18.2 %), 1071 (53.1 %), 388 (19.2 %) and 190 (9.4 %), respectively. Median time from to diagnosis to treatment was 51 (IQR 29-70) days. Time to surgery was 56 (IQR 32-75), 52 (IQR 30-70), 45 (IQR 24-60) and 41 (IQR 22-57) days for localized low, intermediate and high risk and locally advanced disease, respectively. Considering 1827 patients with localized PCa, at multivariate analysis ISUP grade group ≥4 on prostate biopsy (HR: 1.30; 95 % CI 1.07-1.86; p = 0.02) and surgical delay only in localized high-risk disease (HR: 1.02; 95 % CI 1.01-1.54; p = 0.02) were confirmed as independent predictors of pathological upstaging to pT3-T4/pN1 disease at final histopathological examination. CONCLUSIONS In localized high-risk disease surgical delay could be associated with a higher risk of adverse pathologic findings.
Collapse
Affiliation(s)
- Fabrizio Di Maida
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Antonio Andrea Grosso
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Luca Lambertini
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Daniele Paganelli
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Marzocco
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Vincenzo Salamone
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Mara Bacchiani
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Rino Oriti
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Gianni Vittori
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Matteo Salvi
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Agostino Tuccio
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy.
| |
Collapse
|
2
|
V Carvalho AS, Broekema B, Brito Fernandes Ó, Klazinga N, Kringos D. Acute care pathway assessed through performance indicators during the COVID-19 pandemic in OECD countries (2020-2021): a scoping review. BMC Emerg Med 2024; 24:19. [PMID: 38273229 PMCID: PMC10811879 DOI: 10.1186/s12873-024-00938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic severely impacted care for non-COVID patients. Performance indicators to monitor acute care, timely reported and internationally accepted, lacked during the pandemic in OECD countries. This study aims to summarize the performance indicators available in the literature to monitor changes in the quality of acute care in OECD countries during the first year and a half of the pandemic (2020-July 2021) and to assess their trends. METHODS Scoping review. Search in Embase and MEDLINE (07-07-2022). Acute care performance indicators and indicators related to acute general surgery were collected and collated following a care pathway approach. Indicators assessing identical clinical measures were grouped under a common indicator title. The trends from each group of indicators were collated (increase/decrease/stable). RESULTS A total of 152 studies were included. 2354 indicators regarding general acute care and 301 indicators related to acute general surgery were included. Indicators focusing on pre-hospital services reported a decreasing trend in the volume of patients: from 225 indicators, 110 (49%) reported a decrease. An increasing trend in pre-hospital treatment times was reported by most of the indicators (n = 41;70%) and a decreasing trend in survival rates of out-of-hospital cardiac arrest (n = 61;75%). Concerning care provided in the emergency department, most of the indicators (n = 752;71%) showed a decreasing trend in admissions across all levels of urgency. Concerning the mortality rate after admission, most of the indicators (n = 23;53%) reported an increasing trend. The subset of indicators assessing acute general surgery showed a decreasing trend in the volume of patients (n = 50;49%), stability in clinical severity at admission (n = 36;53%), and in the volume of surgeries (n = 14;47%). Most of the indicators (n = 28;65%) reported no change in treatment approach and stable mortality rate (n = 11,69%). CONCLUSION This review signals relevant disruptions across the acute care pathway. A subset of general surgery performance indicators showed stability in most of the phases of the care pathway. These results highlight the relevance of assessing this care pathway more regularly and systematically across different clinical entities to monitor disruptions and to improve the resilience of emergency services during a crisis.
Collapse
Affiliation(s)
- Ana Sofia V Carvalho
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
| | - Bente Broekema
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Pediatrics, Dijklander Hospital, Location Hoorn, Maelsonstraat 3, Hoorn, 1624 NP, The Netherlands
| | - Óscar Brito Fernandes
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Niek Klazinga
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Dionne Kringos
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| |
Collapse
|
3
|
Üntan İ. How did COVID-19 affect acute urolithiasis? An inner Anatolian experience. ULUS TRAVMA ACIL CER 2023; 29:780-785. [PMID: 37409918 PMCID: PMC10405038 DOI: 10.14744/tjtes.2023.36067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 07/07/2023]
Abstract
BACKGROUND The COVID-19 pandemic has changed the number of patients seeking medical help from the emergency service (ES) with non-COVID complaints, consequencing in postponed presentations of different surgical and medical situations. Acute urinary stone disease is one of these situations and needs to be investigated in terms of the effect of COVID-19 on its presentation to the ES. METHODS In this observational, retrospective, and single-center study, we scanned each abdominopelvic computed tomography requested in ES for possible acute urolithiasis during 1 year before and after the outbreak of COVID-19. We searched to state the number of abdominopelvic computed tomographies applied and the number of ratifying urinary stone positivity. We enrolled patients' gender, age, stone location, and stone size. We also recorded C-reactive protein, leukocyte count, and creatinine and noted how long the patients suffering from pain, the duration until the intervention, and the management option selected for each case. RESULTS Total number of abdominopelvic computed tomographies performed was 1089. Of these, 517 were pre-pandemic and 572 were peri-pandemic. The number of pre and peri-pandemic stone-positive scans were, respectively, 363 (70.2%) and 379 (66.2%) (P=0.643). The females' percentage in the COVID-19 period (37.2%) was significantly lower than in the pre-pandemic period (54.3%) (P=0.013). The median size of ureter stones of the pre and peri-pandemic groups were, respectively, 4.8 mm and 3.9 mm depicting no significant difference (P=0.197). No significant difference was sighted between the pre and peri-pandemic groups concerning stone locations, blood parameters, painful duration, treatment options, and time to intervention. CONCLUSION The COVID-19 pandemic resulted in neither sicker nor fewer patients suffering from acute ureteric colic in the ES.
Collapse
Affiliation(s)
- İbrahim Üntan
- Department of Urology, Ahi Evran University Training and Research Hospital, Kirsehir-Türkiye
| |
Collapse
|
4
|
Zapała P, Ślusarczyk A, Rajwa P, Przydacz M, Krajewski W, Dybowski B, Kubik P, Kuffel B, Przudzik M, Osiecki R, Stamirowski R, Zapała Ł, Kozikowski M, Chorągwicki D, Szymańska M, Kiełb P, Małkiewicz B, Zostawa J, Roslan M, Zajączkowska J, Jarzemski M, Brzoszczyk B, Petrasz P, Jarzemski P, Zdrojowy R, Dobruch J, Paradysz A, Drewa T, Chłosta P, Radziszewski P. Not as black as it is painted? The impact of the first wave of COVID-19 pandemic on surgical treatment of urological cancer patients in Poland - a cross-country experience. Arch Med Sci 2023; 19:107-115. [PMID: 36817674 PMCID: PMC9897107 DOI: 10.5114/aoms/130927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/27/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In the majority of Western European countries, the coronavirus disease (COVID-19) pandemic has led to a dramatic reduction in urooncological surgeries. Our objective was to evaluate the impact of the pandemic on volume and patterns of urooncological surgery in Poland. MATERIAL AND METHODS This is a retrospective analysis of 10 urologic centres in Poland. Data regarding major oncological procedures performed after the COVID-19 pandemic outbreak (March 15, 2020 - May 31, 2020) were evaluated and compared with data from the respective period in 2019. RESULTS Between March 15, 2020 and May 31, 2020, a total of 968 oncological procedures were performed in participating centres. When compared to the respective period in 2019 (1063 procedures) the overall number of surgeries declined by 8.9%. The reduction was observed for transurethral resection of bladder tumour (TURBT) (20.1%) and partial nephrectomies (PN) (16.5%). Surgical activity considering radical nephrectomy (RN), nephroureterectomy (NU), and radical prostatectomy (RP) remained relatively unchanged, whereas radical cystectomy (RC) burden showed a significant increase (90.9%). Characteristics of patients treated with TURBT, RC, NU, PN, and RN did not differ significantly between the compared periods, whereas RP in the COVID-19 period was performed more frequently in patients with a higher grade group (p = 0.028) and positive digital rectal examination (p = 0.007). CONCLUSIONS Surgical activity for urological cancers in Poland has been maintained during the first wave of the COVID-19 pandemic. The Polish strategy in the initial period of the COVID-19 crisis mirrors the scenario of hard initial lockdown followed by adaptive lockdown, during which oncological care remained undisrupted and did not require particular priority triage.
Collapse
Affiliation(s)
- Piotr Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Aleksander Ślusarczyk
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Rajwa
- Department of Urology, Medical University of Silesia, Katowice, Poland
| | - Mikołaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Krajewski
- Department of Urology and Oncologic Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Bartosz Dybowski
- Department of Urology, Roefler Memorial Hospital, Pruszkow, Poland
| | - Przemysław Kubik
- Department of General and Oncologic Urology, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Błażej Kuffel
- Department of General and Oncologic Urology, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Maciej Przudzik
- Department of Urology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | - Rafał Osiecki
- Department of Urology, Centre of Postgraduate Medical Education, Professor W. Orłowski Independent Public Teaching Hospital, Warsaw, Poland
| | - Remigiusz Stamirowski
- Department of Urology and Urooncology, Multispecialty Regional Hospital, Gorzow Wielkopolski, Poland
| | - Łukasz Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Mieszko Kozikowski
- Department of Urology, Centre of Postgraduate Medical Education, Professor W. Orłowski Independent Public Teaching Hospital, Warsaw, Poland
| | - Dominik Chorągwicki
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Szymańska
- Department of General and Oncologic Urology, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Paweł Kiełb
- Department of Urology and Oncologic Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Bartosz Małkiewicz
- Department of Urology and Oncologic Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek Zostawa
- Department of Urology, Medical University of Silesia, Katowice, Poland
| | - Marek Roslan
- Department of Urology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | - Joanna Zajączkowska
- Department of Urology and Urooncology, Multispecialty Regional Hospital, Gorzow Wielkopolski, Poland
| | - Marcin Jarzemski
- Department of Urology, Jan Biziel University Hospital, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Bartosz Brzoszczyk
- Department of Urology, Jan Biziel University Hospital, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Piotr Petrasz
- Department of Urology and Urooncology, Multispecialty Regional Hospital, Gorzow Wielkopolski, Poland
| | - Piotr Jarzemski
- Department of Urology, Jan Biziel University Hospital, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Romuald Zdrojowy
- Department of Urology and Oncologic Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Jakub Dobruch
- Department of Urology, Centre of Postgraduate Medical Education, Professor W. Orłowski Independent Public Teaching Hospital, Warsaw, Poland
| | - Andrzej Paradysz
- Department of Urology, Medical University of Silesia, Katowice, Poland
| | - Tomasz Drewa
- Department of General and Oncologic Urology, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Piotr Chłosta
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
5
|
Alelyani RH, Alghamdi AH, Mahrous SM, Alamri BM, Alhiniah MH, Abduh MS, Aldaqal SM. Impact of COVID-19 Pandemic Lockdown on the Prognosis, Morbidity, and Mortality of Patients Undergoing Elective and Emergency Abdominal Surgery: A Retrospective Cohort Study in a Tertiary Center, Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15660. [PMID: 36497733 PMCID: PMC9735974 DOI: 10.3390/ijerph192315660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
The SARS-CoV-2 pandemic's main concerns are limiting the spread of infectious diseases and upgrading the delivery of health services, infrastructure, and therapeutic provision. The goal of this retrospective cohort study was to evaluate the emergency experience and delay of elective abdominal surgical intervention at King Abdul-Aziz University Hospital from October 2019 to October 2020, with a focus on post-operative morbidity and mortality before and during the COVID-19 pandemic. This study compares two groups of patients with emergent and elective abdominal surgical procedures between two different periods; the population was divided into two groups: the control group, which included 403 surgical patients, and the lockdown group, which included 253 surgical patients. During the lockdown, surgical activity was reduced by 37.2% (p = 0.014), and patients were more likely to require reoperations and blood transfusions during or after surgery (p= 0.002, 0.021, and 0.018, respectively). During the lockdown period, the average length of stay increased from 3.43 to 5.83 days (p = 0.002), and the patients who developed complications (53.9%) were more than those in the control period (46.1%) (p = 0.001). Our tertiary teaching hospital observed a significant decline in the overall number of surgeries performed during the COVID-19 pandemic and lockdown period. During the lockdown, abdominal surgery was performed only on four patients; they were positive for COVID-19. Three of them underwent exploratory laparotomy; two of the three developed shock post-operative; one patient had colon cancer (ASA score 3), one had colon disease (ASA score 2), and two had perforated bowels (ASA scores 2 and 4, respectively). Two out of four deaths occurred after surgery. Our results showed the impact of the COVID-19 lockdown on surgical care as both 30-day mortality and total morbidity have risen considerably.
Collapse
Affiliation(s)
- Rakan H Alelyani
- College of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ali H Alghamdi
- College of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Saad M Mahrous
- College of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Bader M Alamri
- College of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mudhawi H Alhiniah
- College of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Maisa S Abduh
- Immune Responses in Different Diseases Research Group, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Saleh M Aldaqal
- Immune Responses in Different Diseases Research Group, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| |
Collapse
|
6
|
Byrne MHV, Georgiades F, Light A, Lovegrove CE, Dominic C, Rahman J, Kathiravelupillai S, Klatte T, Saeb‐Parsy K, Kumar R, Howles S, Stewart GD, Turney B, Wiseman O. Impact of COVID-19 on the management and outcomes of ureteric stones in the UK: a multicentre retrospective study. BJU Int 2022; 131:82-89. [PMID: 36083711 PMCID: PMC9539039 DOI: 10.1111/bju.15882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To determine if management of ureteric stones in the UK changed during the coronavirus disease 2019 (COVID-19) pandemic and whether this affected patient outcomes. PATIENTS AND METHODS We conducted a multicentre retrospective study of adults with computed tomography-confirmed ureteric stone disease at 39 UK hospitals during a pre-pandemic period (23/3/2019-22/6/2019) and a period during the pandemic (the 3-month period after the first severe acute respiratory syndrome coronavirus-2 case at individual sites). The primary outcome was success of primary treatment modality, defined as no further treatment required for the index ureteric stone. Our study protocol was published prior to data collection. RESULTS A total of 3735 patients were included (pre-pandemic 1956 patients; pandemic 1779 patients). Stone size was similar between groups (P > 0.05). During the pandemic, patients had lower hospital admission rates (pre-pandemic 54.0% vs pandemic 46.5%, P < 0.001), shorter mean length of stay (4.1 vs 3.3 days, P = 0.02), and higher rates of use of medical expulsive therapy (17.4% vs 25.4%, P < 0.001). In patients who received interventional management (pre-pandemic 787 vs pandemic 685), rates of extracorporeal shockwave lithotripsy (22.7% vs 34.1%, P < 0.001) and nephrostomy were higher (7.1% vs 10.5%, P = 0.03); and rates of ureteroscopy (57.2% vs 47.5%, P < 0.001), stent insertion (68.4% vs 54.6%, P < 0.001), and general anaesthetic (92.2% vs 76.2%, P < 0.001) were lower. There was no difference in success of primary treatment modality between patient cohorts (pre-pandemic 73.8% vs pandemic 76.1%, P = 0.11), nor when patients were stratified by treatment modality or stone size. Rates of operative complications, 30-day mortality, and re-admission and renal function at 6 months did not differ between the data collection periods. CONCLUSIONS During the COVID-19 pandemic, there were lower admission rates and fewer invasive procedures performed. Despite this, there were no differences in treatment success or outcomes. Our findings indicate that clinicians can safely adopt management strategies developed during the pandemic to treat more patients conservatively and in the community.
Collapse
Affiliation(s)
- Matthew H V Byrne
- Nuffield Department of Surgical SciencesUniversity of OxfordUK,Oxford University Hospitals NHS Foundation TrustUK
| | - Fanourios Georgiades
- Department of SurgeryUniversity of CambridgeUK,Cambridge University Hospitals NHS Foundation TrustUK
| | | | - Catherine E Lovegrove
- Nuffield Department of Surgical SciencesUniversity of OxfordUK,Oxford University Hospitals NHS Foundation TrustUK
| | - Catherine Dominic
- Barts and the London School of Medicine, Queen Mary University of LondonUK
| | | | | | - Tobias Klatte
- Department of UrologyCharité ‐ Universitätsmedizin BerlinGermany
| | | | - Rajeev Kumar
- Nuffield Department of Surgical SciencesUniversity of OxfordUK
| | - Sarah Howles
- Nuffield Department of Surgical SciencesUniversity of OxfordUK,Oxford University Hospitals NHS Foundation TrustUK
| | - Grant D Stewart
- Department of SurgeryUniversity of CambridgeUK,Cambridge University Hospitals NHS Foundation TrustUK
| | - Ben Turney
- Nuffield Department of Surgical SciencesUniversity of OxfordUK,Oxford University Hospitals NHS Foundation TrustUK
| | | | | |
Collapse
|
7
|
Pirola GM, Rubilotta E, Castellani D, Pancani F, Rosadi S, Giannantoni A, Asimakopoulos AD, Gubbiotti M. Increased risk of transurethral and suprapubic catheter self-extraction in COVID-19 patients: real-life experience. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S24-S30. [PMID: 35559699 DOI: 10.12968/bjon.2022.31.9.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION This study evaluated the prevalence of transurethral catheter self-removal in critically-ill COVID-19 non-sedated adult patients compared with non-COVID-19 controls. METHODS COVID-19 patients who self-extracted transurethral or suprapubic catheters needing a urological intervention were prospectively included (group A). Demographic data, medical and nursing records, comorbidities and nervous system symptoms were evaluated. Agitation, anxiety and delirium were assessed by the Richmond Agitation and Sedation Scale (RASS). The control group B were non-COVID-19 patients who self-extracted transurethral/suprapubic catheter in a urology unit (subgroup B1) and geriatric unit (subgroup B2), requiring a urological intervention in the same period. RESULTS 37 men and 11 women were enrolled in group A. Mean RASS score was 3.1 ± 1.8. There were 5 patients in subgroup B1 and 11 in subgroup B2. Chronic comorbidities were more frequent in group B than the COVID-19 group (P<0.01). COVID-19 patients had a significant difference in RASS score (P<0.006) and catheter self-extraction events (P<0.001). Complications caused by traumatic catheter extractions (severe urethrorrhagia, longer hospital stay) were greater in COVID-19 patients. CONCLUSION This is the first study focusing on the prevalence and complications of catheter self-removal in COVID-19 patients. An increased prevalence of urological complications due to agitation and delirium related to COVID-19 has been demonstrated-the neurological sequelae of COVID-19 must be considered during hospitalisation.
Collapse
Affiliation(s)
- Giacomo Maria Pirola
- Medical Doctor, Urologist, Department of Urology, San Donato Hospital, Arezzo, Italy
| | | | - Daniele Castellani
- Medical Doctor, Urologist, Department of Urology, Ospedali Riuniti di Ancona, Le Marche Polytechnic University, Ancona, Italy
| | - Flavia Pancani
- Medical Doctor, Anaesthetist, Department of Anaesthesia, San Donato Hospital, Arezzo, Italy
| | - Stefano Rosadi
- Medical Doctor, Urologist, Department of Urology, San Donato Hospital, Arezzo, Italy
| | - Antonella Giannantoni
- Professor, Medical Doctor, Urologist, Department of Medical and Surgical Sciences and Neurosciences, Functional and Surgical Urology Unit, University of Siena, Italy
| | | | - Marilena Gubbiotti
- Medical Doctor, Urologist, Department of Urology, San Donato Hospital, Arezzo, Italy
| |
Collapse
|
8
|
Shivakumar N, Nantha Kumar D, Joshi H. The Impact of early COVID-19 pandemic on the Presentation and Management of Urinary Calculi Across the Globe - A Systematic Review. J Endourol 2022; 36:1255-1264. [PMID: 35473404 DOI: 10.1089/end.2022.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction It is acknowledged that the COVID-19 pandemic has had a major impact on healthcare services around the globe with possible worse outcomes. It has resulted in stretch of resources with cancelled or delayed procedures. Patients with urinary calculi have also suffered the negative impact. This systematic review aims to assess the impact of the early COVID-19 pandemic on the presentation and management of urinary calculi around the globe. Methods We reviewed the impact of early COVID-19 on the clinically important aspects of stone disease using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We searched Medline, Embase and Central databases using themes of (COVID-19 OR Sars-Cov-2 OR pandemic OR coronavirus AND kidney stone, urinary calculi, urolithiasis and similar allied terms. Inclusion criteria were studies with data on both pre and COVID-19 period covering one or more of eight clinical domains. Results Our search returned 231 studies, after removal of duplicates, of which 18 studies were included for analysis. The number of patients presenting to hospital declined by 21-70% at the beginning of the pandemic while majority of studies reported increased associated complications. There are mixed reports in terms of delay to presentation and use of conservative management. There was a consistent trend towards reduction in elective procedures with wide variations (shock wave lithotripsy 38-98%, PCNL 94-100% and ureteroscopy 8%-98%) There was a trend towards increased nephrostomy insertion with the onset of the pandemic. Conclusion This review demonstrated the differences in the number of patients presenting to hospital, complication rates and management of urinary calculi, including surgical interventions, with the onset of the COVID-19 pandemic. It offers baseline global information that would help understand the impact of early pandemic, variations in practices and be useful for future comparisons.
Collapse
Affiliation(s)
- Natesh Shivakumar
- University Hospital of Wales, 97609, Urology Department, Cardiff, United Kingdom of Great Britain and Northern Ireland;
| | - Dhanya Nantha Kumar
- Cardiff University, 2112, School of Medicine, Cardiff, United Kingdom of Great Britain and Northern Ireland;
| | - Hrishi Joshi
- University Hospital of Wales, 97609, Urology Department, Cardiff, United Kingdom of Great Britain and Northern Ireland.,Cardiff University, 2112, School of Medicine, Cardiff, United Kingdom of Great Britain and Northern Ireland;
| |
Collapse
|
9
|
Changes in Surgical Volume and Outcomes During the Coronavirus Disease 2019 Pandemic at Two Tertiary Hospitals in Ethiopia: A Retrospective Cohort Study. Anesth Analg 2022; 134:1297-1307. [PMID: 35171877 DOI: 10.1213/ane.0000000000005946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Limited data exist concerning how the coronavirus disease 2019 (COVID-19) pandemic has affected surgical care in low-resource settings. We sought to describe associations between the COVID-19 pandemic and surgical care and outcomes at 2 tertiary hospitals in Ethiopia. METHODS We conducted a retrospective observational cohort study analyzing perioperative data collected electronically from Ayder Comprehensive Specialized Hospital (ACSH) in Mekelle, Ethiopia, and Tibebe Ghion Specialized Hospital (TGSH) in Bahir Dar, Ethiopia. We categorized COVID-19 exposure as time periods: "phase 0" before the pandemic (November 1-December 31, 2019, at ACSH and August 1-September 30, 2019, at TGSH), "phase 1" starting when elective surgeries were canceled (April 1-August 3, 2020, at ACSH and March 28-April 12, 2020, at TGSH), and "phase 2" starting when elective surgeries resumed (August 4-August 31, 2020, at ACSH and April 13-August 31, 2020, at TGSH). Outcomes included 28-day perioperative mortality, case volume, and patient district of origin. Incidence rates of case volume and patient district of origin (outside district yes or no) were modeled with segmented Poisson regression and logistic regression, respectively. Association of the exposure with 28-day mortality was assessed using logistic regression models, adjusting for confounders. RESULTS Data from 3231 surgeries were captured. There was a decrease in case volume compared to phase 0, with adjusted incidence rate ratio (IRR) of 0.73 (95% confidence interval [CI], 0.66-0.81) in phase 1 and 0.90 (95% CI, 0.83-0.97) in phase 2. Compared to phase 0, there were more patients from an outside district during phase 1 lockdown at ACSH (adjusted odds ratio [aOR], 1.63 [95% CI, 1.24-2.15]) and fewer patients from outside districts at TGSH (aOR, 0.44 [95% CI, 0.21-0.87]). The observed 28-day mortality rates for phases 0, 1, and 2 were 1.8% (95% CI, 1.1-2.8), 3.7% (95% CI, 2.3-5.8), and 2.9% (95% CI, 2.1-3.9), respectively. A confounder-adjusted logistic regression model did not show a significant increase in 28-day perioperative mortality during phases 1 and 2 compared to phase 0, with aOR 1.36 (95% CI, 0.62-2.98) and 1.54 (95% CI, 0.80-2.95), respectively. CONCLUSIONS Analysis at 2 low-resource referral hospitals in Ethiopia during the COVID-19 pandemic showed a reduction in surgical case volume during and after lockdown. At ACSH, more patients were from outside districts during lockdown where the opposite was true at TGSH. These findings suggest that during the pandemic patients may experience delays in seeking or obtaining surgical care. However, for patients who underwent surgery, prepandemic and postpandemic perioperative mortalities did not show significant difference. These results may inform surgical plans during future public health crises.
Collapse
|
10
|
Norton SM, Considine S, Dowling C, D'Arcy F. Where are the paediatric patients with testicular torsion during the COVID-19 pandemic? Ir J Med Sci 2021; 191:2423-2426. [PMID: 34664222 PMCID: PMC8523118 DOI: 10.1007/s11845-021-02803-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/22/2021] [Indexed: 11/30/2022]
Abstract
Introduction The Irish people were put on lockdown in mid-March 2020 due to concern of the spread of coronavirus. With these societal changes came a notable reduction in emergency department attendance. Our aim was to analyse emergency urological procedures performed during the COVID-19 era versus the previous year. Methods A retrospective review of theatre logbooks was undertaken comparing numbers of emergency urological procedures performed between 1 March 2020 and 31 May 2020 (i.e. the COVID-19 era) with the corresponding 3-month period in 2019. Results A total of 173 cases were analysed between the two time periods. Similar overall numbers of cases were performed in 2019 (n = 90) and 2020 (n = 83). In particular, similar patient case numbers are also noted in both scrotal explorations (13 vs 9) and ureteric stone surgeries (69 vs 70). However, orchidectomies for testicular cancers were reduced by 63% (3/8). On further analysis of the scrotal exploration group, only 3 were performed in the period after lockdown regulations were instated. Conclusion Whilst patients with ureteric colic continue to present, those with acute testis pain requiring exploration attended less frequently, raising the possibility of undiagnosed testicular torsion in the community.
Collapse
Affiliation(s)
- Sarah Marie Norton
- Department of Urology, Galway University Hospital, Newcastle Road, Galway, Ireland.
| | - Shane Considine
- Department of Urology, Galway University Hospital, Newcastle Road, Galway, Ireland
| | - Catherine Dowling
- Department of Urology, Galway University Hospital, Newcastle Road, Galway, Ireland
| | - Frank D'Arcy
- Department of Urology, Galway University Hospital, Newcastle Road, Galway, Ireland
| |
Collapse
|
11
|
Frumer M, Aharony SM, Shoshany O, Kedar D, Baniel J, Golan S. Trends in urological emergencies in the Era of COVID-19. Int Braz J Urol 2021; 47:997-1005. [PMID: 34260177 PMCID: PMC8321443 DOI: 10.1590/s1677-5538.ibju.2020.1092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/24/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate trends in emergency room (ER) urological conditions during COVID-19 pandemic lockdown. MATERIALS AND METHODS Retrospective analyses of renal colic, hematuria, and urinary retention in ER's admissions of a tertiary hospital during the lockdown period (March 19 to May 4, 2020) in Israel. Patient's demographics and clinical characteristics were compared to those in corresponding periods during 2017-2019, with estimated changes in ER arrival and waiting times, utilization of imaging tests, numbers of hospitalizations, and urgent procedure rates. RESULTS The number of ER visits for renal colic, hematuria, and urinary retention decreased by 37%, from an average of 451 (2017-2019) to 261 patients (2020). Clinical severity was similar between groups, with no major differences in patient's age, vital signs, or laboratory results. The proportion of ER visits during night hours increased significantly during lockdown (44.8% vs. 34.2%, p=0.002). There was a decrease in renal colic admission rate from 19.8% to 8.4% (p=0.001) without differences in urgent procedures rates, while the 30-day revisit rate decreased from 15.8% to 10.3% during lockdown (p=0.02). CONCLUSIONS General lockdown was accompanied by a significant decrease in common urological presentations to the ER. This change occurred across the clinical severity spectrum of renal colic, hematuria, and urinary retention. In the short term, it appears that patients who sought treatment did not suffer from complications that could be attributed to late arrival or delay in treatment. The long-term implications of abstinence from seeking emergent care are not known and require further investigation.
Collapse
Affiliation(s)
- Michael Frumer
- Rabin Medical CenterDepartment of UrologyPetach TikvaIsraelDepartment of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Shachar M. Aharony
- Rabin Medical CenterDepartment of UrologyPetach TikvaIsraelDepartment of Urology, Rabin Medical Center, Petach Tikva, Israel
- Tel Aviv UniversitySackler Faculty of MedicineTel AvivIsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Shoshany
- Rabin Medical CenterDepartment of UrologyPetach TikvaIsraelDepartment of Urology, Rabin Medical Center, Petach Tikva, Israel
- Tel Aviv UniversitySackler Faculty of MedicineTel AvivIsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Kedar
- Rabin Medical CenterDepartment of UrologyPetach TikvaIsraelDepartment of Urology, Rabin Medical Center, Petach Tikva, Israel
- Tel Aviv UniversitySackler Faculty of MedicineTel AvivIsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jack Baniel
- Rabin Medical CenterDepartment of UrologyPetach TikvaIsraelDepartment of Urology, Rabin Medical Center, Petach Tikva, Israel
- Tel Aviv UniversitySackler Faculty of MedicineTel AvivIsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shay Golan
- Rabin Medical CenterDepartment of UrologyPetach TikvaIsraelDepartment of Urology, Rabin Medical Center, Petach Tikva, Israel
- Tel Aviv UniversitySackler Faculty of MedicineTel AvivIsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
12
|
Ciarleglio FA, Rigoni M, Mereu L, Tommaso C, Carrara A, Malossini G, Tateo S, Tirone G, Bjerklund Johansen TE, Benetollo PP, Ferro A, Guarrera GM, Grattarola M, Nollo G, Brolese A. The negative effects of COVID-19 and national lockdown on emergency surgery morbidity due to delayed access. World J Emerg Surg 2021; 16:37. [PMID: 34256781 PMCID: PMC8276199 DOI: 10.1186/s13017-021-00382-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/26/2021] [Indexed: 02/06/2023] Open
Abstract
Background The aim of this retrospective comparative study was to assess the impact of COVID-19 and delayed emergency department access on emergency surgery outcomes, by comparing the main clinical outcomes in the period March–May 2019 (group 1) with the same period during the national COVID-19 lockdown in Italy (March–May 2020, group 2). Methods A comparison (groups 1 versus 2) and subgroup analysis were performed between patients’ demographic, medical history, surgical, clinical and management characteristics. Results Two-hundred forty-six patients were included, 137 in group 1 and 109 in group 2 (p = 0.03). No significant differences were observed in the peri-operative characteristics of the two groups. A declared delay in access to hospital and preoperative SARS-CoV-2 infection rates were 15.5% and 5.8%, respectively in group 2. The overall morbidity (OR = 2.22, 95% CI 1.08–4.55, p = 0.03) and 30-day mortality (OR = 1.34, 95% CI 0.33–5.50, =0.68) were significantly higher in group 2. The delayed access cohort showed a close correlation with increased morbidity (OR = 3.19, 95% CI 0.89–11.44, p = 0.07), blood transfusion (OR = 5.13, 95% CI 1.05–25.15, p = 0.04) and 30-day mortality risk (OR = 8.00, 95% CI 1.01–63.23, p = 0.05). SARS-CoV-2-positive patients had higher risk of blood transfusion (20% vs 7.8%, p = 0.37) and ICU admissions (20% vs 2.6%, p = 0.17) and a longer median LOS (9 days vs 4 days, p = 0.11). Conclusions This article provides enhanced understanding of the effects of the COVID-19 pandemic on patient access to emergency surgical care. Our findings suggest that COVID-19 changed the quality of surgical care with poorer prognosis and higher morbidity rates. Delayed emergency department access and a “filter effect” induced by a fear of COVID-19 infection in the population resulted in only the most severe cases reaching the emergency department in time.
Collapse
Affiliation(s)
- Francesco A Ciarleglio
- General Surgery II & HPB Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Santa Chiara Hospital, Largo Medaglie d'Oro, 1, 38122, Trento, Italy.
| | - Marta Rigoni
- IRCS - Innovation and Clinical Health Research - Bruno Kessler Foundation (FBK), 38123, Trento, Italy.,Department of Industrial Engineering, BIOtech Lab, University of Trento, 38122, Trento, Italy
| | - Liliana Mereu
- Obstetrics and Gynaecology Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Santa Chiara Hospital, 38122, Trento, Italy
| | - Cai Tommaso
- Urology Unit, APSS, Azienda Provinciale per i Servizi Sanitari (APSS), Santa Chiara Hospital, 38122, Trento, Italy
| | - Alessandro Carrara
- General Surgery I & Thoracic Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Santa Chiara Hospital, 38122, Trento, Italy
| | - Gianni Malossini
- Urology Unit, APSS, Azienda Provinciale per i Servizi Sanitari (APSS), Santa Chiara Hospital, 38122, Trento, Italy
| | - Saverio Tateo
- Obstetrics and Gynaecology Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Santa Chiara Hospital, 38122, Trento, Italy
| | - Giuseppe Tirone
- General Surgery I & Thoracic Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Santa Chiara Hospital, 38122, Trento, Italy
| | - Truls E Bjerklund Johansen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Urology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Pier Paolo Benetollo
- Provincial Health Care Agency Staff Management, Azienda Provinciale per i Servizi Sanitari (APSS), Santa Chiara Hospital, Trento, Italy
| | - Antonio Ferro
- Provincial Health Care Agency Staff Management, Azienda Provinciale per i Servizi Sanitari (APSS), Santa Chiara Hospital, Trento, Italy
| | - Giovanni Maria Guarrera
- Provincial Health Care Agency Staff Management, Azienda Provinciale per i Servizi Sanitari (APSS), Santa Chiara Hospital, Trento, Italy
| | - Mario Grattarola
- Provincial Health Care Agency Staff Management, Azienda Provinciale per i Servizi Sanitari (APSS), Santa Chiara Hospital, Trento, Italy
| | - Giandomenico Nollo
- IRCS - Innovation and Clinical Health Research - Bruno Kessler Foundation (FBK), 38123, Trento, Italy.,Department of Industrial Engineering, BIOtech Lab, University of Trento, 38122, Trento, Italy
| | - Alberto Brolese
- General Surgery II & HPB Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Santa Chiara Hospital, Largo Medaglie d'Oro, 1, 38122, Trento, Italy
| |
Collapse
|
13
|
Minervini A, Di Maida F, Mari A, Porreca A, Rocco B, Celia A, Bove P, Umari P, Volpe A, Galfano A, Pastore AL, Annino F, Parma P, Greco F, Nucciotti R, Schiavina R, Esposito F, Romagnoli D, Leonardo C, Falabella R, Gallo F, Amenta M, Sciorio C, Verze P, Tafuri A, Pucci L, Varca V, Zaramella S, Pagliarulo V, Bozzini G, Ceruti C, Falsaperla M, Cafarelli A, Antonelli A. Perioperative outcomes of patients undergoing urological elective surgery during the COVID-19 pandemic: a national overview across 28 Italian institutions. Cent European J Urol 2021; 74:259-268. [PMID: 34336248 PMCID: PMC8318031 DOI: 10.5173/ceju.2021.0374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/02/2021] [Accepted: 04/08/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction The aim of this study was to assess the safety of elective urological surgery performed during the pandemic by estimating the prevalence of COVID-19-like symptoms in the postoperative period and its correlation with perioperative and clinical factors. Material and methods In this multicenter, observational study we recorded clinical, surgical and postoperative data of consecutive patients undergoing elective urological surgery in 28 different institutions across Italy during initial stage of the COVID-19 pandemic (between February 24 and March 30, 2020, inclusive). Results A total of 1943 patients were enrolled. In 12%, 7.1%, 21.3%, 56.7% and 2.6% of cases an open, laparoscopic, robotic, endoscopic or percutaneous surgical approach was performed, respectively. Overall, 166 (8.5%) postoperative complications were registered, 77 (3.9%) surgical and 89 (4.6%) medical. Twenty-eight (1.4%) patients were readmitted to hospital after discharge and 13 (0.7%) died. In the 30 days following discharge, fever and respiratory symptoms were recorded in 101 (5.2%) and 60 (3.1%) patients. At multivariable analysis, not performing nasopharyngeal swab at hospital admission (HR 2.3; CI 95% 1.01–5.19; p = 0.04) was independently associated with risk of developing postoperative medical complications. Number of patients in the facility was confirmed as an independent predictor of experiencing postoperative respiratory symptoms (p = 0.047, HR:1.12; CI95% 1.00–1.05), while COVID-19-free type of hospitalization facility was a strong independent protective factor (p = 0.02, HR:0.23, CI95% 0.07–0.79). Conclusions Performing elective surgery during the COVID-19 pandemic does not seem to affect perioperative outcomes as long as proper preventive measures are adopted, including nasopharyngeal swab before hospital admission and hospitalization in dedicated COVID-19-free facilities.
Collapse
Affiliation(s)
- Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Fabrizio Di Maida
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Angelo Porreca
- Department of Oncological Urology - Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy
| | - Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo Dipartimento di Scienze della Salute - Università degli Studi di Milano, Milano, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Pierluigi Bove
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - Paolo Umari
- Division of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Alessandro Volpe
- Division of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | | | - Antonio Luigi Pastore
- Department of Medical-Surgical Sciences and Biotechnologies, 'Sapienza' University of Rome, Urology Unit ICOT, Latina, Italy
| | | | - Paolo Parma
- Urology Department, Ospedale Poma, Mantova, Italy
| | | | | | | | - Fabio Esposito
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Daniele Romagnoli
- Department of Oncological Urology - Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy
| | | | - Roberto Falabella
- Department of Urology, Azienda Ospedaliera Regionale di Potenza, Potenza, Italy
| | - Fabrizio Gallo
- Department of Urology, San Paolo Hospital, Savona, Italy
| | | | | | - Paolo Verze
- Department of Urology, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Alessandro Tafuri
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Italy
| | - Luigi Pucci
- Department of Urology, AORN A. Cardarelli, Naples, Italy
| | - Virginia Varca
- Hospital G. Salvini, ASST Rhodense Garbagnate Milanese, Milan, Italy
| | | | | | - Giorgio Bozzini
- Urology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - Carlo Ceruti
- SCDU Urologia, Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Italy
| | | |
Collapse
|
14
|
Anderson S, McNicholas D, Murphy C, Cheema I, McLornan L, Davis N, Quinlan M. The impact of COVID-19 on acute urinary stone presentations: a single-centre experience. Ir J Med Sci 2021; 191:45-49. [PMID: 33629270 PMCID: PMC7904391 DOI: 10.1007/s11845-021-02562-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/17/2021] [Indexed: 01/19/2023]
Abstract
Background The COVID-19 pandemic has seen a change in the numbers of patients presenting to the emergency department (ED) with non-COVID symptoms, resulting in delayed presentations of many medical and surgical conditions. Aims To examine the impact of COVID-19 on acute urolithiasis presentations to the ED. Methods In this retrospective, single-centre, observational study, we reviewed all CT KUBs (and their corresponding cases) ordered in ED for possible acute urolithiasis in a 100-day period immediately prior to COVID-19 and in a 100-day period immediately afterwards. We sought to establish the number of CT KUBs performed and the number confirming urolithiasis. We recorded patients’ age, gender, stone size and location. We also analysed CRP, WCC and creatinine as well as the duration of patients’ pain and the management strategy adopted for each case. Results One hundred ninety-eight CT KUBs were performed, 94 pre-COVID and 104 intra-COVID. A total of 70.2% (n = 66) and 66.3% (n = 69) were positive for urolithiasis pre-COVID and intra-COVID respectively (p = 0.56). There was a significantly higher percentage of females pre-COVID compared with intra-COVID (54% vs 36%, p = 0.012). There was no difference in median ureteric stone size seen between the groups (4.7 mm pre-COVID vs 4.0 mm intra-COVID, p = 0.179). There were no significant differences in WCC, CRP or creatinine levels. One patient in the pre-COVID group and two in the intra-COVID groups required percutaneous nephrostomies. Conclusion The COVID-19 pandemic did not result in fewer or sicker patients presenting with acute ureteric colic cases to the ED.
Collapse
Affiliation(s)
- Steven Anderson
- Dept of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Daniel McNicholas
- Dept of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Claudine Murphy
- Dept of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Ijaz Cheema
- Dept of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Liza McLornan
- Dept of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Niall Davis
- Dept of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland.,Dept of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mark Quinlan
- Dept of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland. .,Dept of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland.
| |
Collapse
|
15
|
Yang X, Zhuang J, Yu H, Cao Q, Li K, Zhou Z, Han J, Lu J, Yuan B, Wu Q, Feng D, Cai L, Yang H, Gu M, Li P, Lu Q. Effect of Coronavirus Disease 2019 on Patients with Bladder Cancer in China. Urol Int 2021; 105:726-728. [PMID: 33626537 DOI: 10.1159/000512895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/09/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Xiao Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Juntao Zhuang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Yu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Cao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zijian Zhou
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Han
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiancheng Lu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Baorui Yuan
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qikai Wu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dexiang Feng
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lingkai Cai
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Haiwei Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Gu
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pengchao Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Lu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,
| |
Collapse
|
16
|
[Urologic cancer care during the first wave of the COVID-19 pandemic : Role of federal cancer registration in Germany]. Urologe A 2021; 60:291-300. [PMID: 33559692 PMCID: PMC7871312 DOI: 10.1007/s00120-021-01454-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/26/2022]
Abstract
Die uroonkologische Therapie hat eine hohe Priorität trotz der bestehenden Einschränkungen während der COVID-19-Pandemie („coronavirus disease 2019“). Die zeitnahe Durchführung und die Art der Behandlung werden durch organisatorische Veränderungen möglicherweise kompliziert. Zur Dokumentation und Objektivierung der versorgten Patienten können verschiedene Register herangezogen werden. Dazu zählen die aktuellen Daten des Instituts für das Entgeltsystem im Krankenhaus (InEK) sowie die Meldungen bei den Krebsregistern der Bundesländer. Wir geben eine Übersicht zur Registrierung der uroonkologischen Versorgungssituation während der ersten Welle der COVID-19-Pandemie sowie ergänzend zu möglichen Komplikationsraten und -mustern bei operativ behandelten Patienten. Bei der Klinischen Landesregisterstelle des Krebsregisters Baden-Württemberg wurden im Jahr 2020 bisher weniger uroonkologische Neudiagnosen gemeldet. Während der Pandemie nahm in Deutschland die Anzahl der operativ behandelten Nierenzell- und Harnblasenkarzinome ab, während bei radikalen Prostatektomien kein Unterschied im Vergleich zu den Vorjahren erkennbar ist. Eine COVID-19-Erkrankung könnte das Risiko für nicht-urologische Komplikationen nach uroonkologischen Operationen erhöhen, jedoch ist die aktuelle Datenlage noch unzureichend.
Collapse
|
17
|
Fahrner R, Bähler S, Lindner G. COVID-19 lock-down significantly reduced number of surgical presentations in an emergency department. Wien Klin Wochenschr 2021; 133:399-402. [PMID: 33507348 PMCID: PMC7841980 DOI: 10.1007/s00508-021-01810-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/08/2021] [Indexed: 11/29/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) is an acute virus infection, which was declared by the World Health Organization (WHO) as a pandemic. As a consequence, the Swiss government decreed a public lock-down to reduce and restrict further infections. The aim of this investigation was to provide the impact of the COVID-19 lock-down on the presentations of patients in an interdisciplinary emergency department (ED). Patients, material and methods A retrospective study was performed at an interdisciplinary Swiss ED during the lock-down period. All patients who presented to the ED were enrolled in this investigation and compared to a control cohort during the same time period in 2019. Data regarding patients’ characteristics, medical specialty, time course of presentations during the observation period, outpatient or hospital admission were analyzed. Results In total 7072 patients were included in the final analysis. During the lock-down period the number of ED presentations significantly decreased by 29% in comparison to the control period in the previous year (p < 0.0001). The analysis of the time course revealed that in each week the number of patients was lower with 13–43% reduction. Irrespective of the medical specialty, the number of presentations decreased during the COVID-19 situation, whereas this decrease was higher in surgical diseases (31%, p < 0.0001) than in non-surgical presentations (3.6%, p = 0.4). Conclusion The socioeconomic lock-down was associated with reduced number of presentations in an ED. Mainly, surgical diseases and injuries were affected in terms of a reduction of presentations during the COVID-19 lock-down period.
Collapse
Affiliation(s)
- René Fahrner
- Department of General, Visceral and Thoracic Surgery, Bürgerspital Solothurn, Schöngrünstraße 42, 4500, Solothurn, Switzerland.
| | - Stefan Bähler
- Department of General, Visceral and Thoracic Surgery, Bürgerspital Solothurn, Schöngrünstraße 42, 4500, Solothurn, Switzerland
| | - Gregor Lindner
- Department of General Internal and Emergency Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| |
Collapse
|
18
|
Borgmann H, Struck JP, Mattigk A, Wenzel M, Pilatz A, Kranz J, Weiten R, von Landenberg N, Spachmann PJ, Aksoy C, Haferkamp A, Boehm K. Increased Severe Adverse Outcomes and Decreased Emergency Room Visits for Pyelonephritis: First Report of Collateral Damage during COVID-19 Pandemic in Urology. Urol Int 2021; 105:199-205. [PMID: 33406523 PMCID: PMC7900463 DOI: 10.1159/000513458] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022]
Abstract
Purpose The coronavirus disease 2019 (COVID-19) pandemic is disrupting urology health-care worldwide. Reduced emergency room visits resulting in adverse outcomes have most recently been reported in pediatrics and cardiology. We aimed to compare patients with emergency room visits for pyelonephritis in 2019 (pre-COVID-19 era) and within the first wave of pandemic in 2020 (COVID-19 era) with regard to the number of visits and severe adverse disease outcomes. Methods We performed a retrospective multicentre study comparing characteristics and outcomes of patients with pyelonephritis, excluding patients with hydronephrosis due to stone disease, in 10 urology departments in Germany during a 1-month time frame in March and April in each 2019 and 2020. Results The number of emergency room visits for pyelonephritis in the COVID-19 era was lower (44 patients, 37.0%) than in the pre-COVID-19 era (76 patients, 63.0%), reduction rate: 42.1% (p = 0.003). Severe adverse disease outcome was more frequent in the COVID-19 era (9/44 patients, 20.5%) than in the pre-COVID-19 era (5/76 patients, 6.6%, p = 0.046). In detail, 7 versus 3 patients needed monitoring (15.9 vs. 3.9%), 2 versus no patients needed intensive-care treatment (4.5 vs. 0%), 2 versus no patients needed drain placement (4.5 vs. 0%), 2 versus no patients had a nephrectomy (4.5 vs. 0%), and 2 versus 1 patient died (4.5 vs. 1.3%). Conclusion This report of collateral damage during COVID-19 showed that emergency room visits were decreased, and severe adverse disease outcomes were increased for patients with pyelonephritis in the COVID-19 era. Health authorities should set up information campaign programs actively encouraging patients to utilize emergency room services in case of severe symptoms specifically during the actual second wave of pandemic.
Collapse
Affiliation(s)
- Hendrik Borgmann
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany,
| | - Julian P Struck
- Department of Urology, University Hospital Luebeck, Luebeck, Germany
| | | | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Jennifer Kranz
- Department of Urology, St.-Antonius Hospital Eschweiler, Eschweiler, Germany.,Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Germany
| | - Richard Weiten
- Department of Urology, University Hospital Bonn, Bonn, Germany
| | | | | | - Cem Aksoy
- Department of Urology, University Hospital Dresden, Dresden, Germany
| | - Axel Haferkamp
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Katharina Boehm
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| |
Collapse
|
19
|
Rajwa P, Przydacz M, Krajewski W, Kuffel B, Zapala P, Krzywon A, Cortez AJ, Dybowski B, Stamirowski R, Jarzemski M, Drobot RB, Stelmach P, Mlynarek K, Marcinek M, Przudzik M, Krawczyk W, Ryszawy J, Choragwicki D, Zapala L, Lipa M, Pozniak M, Janczak D, Słomian S, Łaszkiewicz J, Nowak M, Miszczyk M, Roslan M, Tkocz M, Zdrojowy R, Potyka A, Szydełko T, Drewa T, Jarzemski P, Radziszewski P, Slojewski M, Antoniewicz A, Paradysz A, Chlosta PL. Changing patterns of urologic emergency visits and admissions during the COVID-19 pandemic: a retrospective, multicenter, nationwide study. Arch Med Sci 2021; 17:1262-1276. [PMID: 34522255 PMCID: PMC8425232 DOI: 10.5114/aoms.2020.98364] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION We aimed to examine the change in the number and severity of visits to the emergency departments (EDs) and subsequent admissions for urgent urologic conditions in the early stage of the coronavirus disease 2019 (COVID-19) pandemic in Poland. MATERIAL AND METHODS We evaluated data from 13 urologic centers in Poland and compared the number of visits to the EDs and subsequent admissions before and after the advent of COVID-19 in 2020, and before and after the escalating national restrictions. Furthermore, data on types of urologic complaints, crucial laboratory parameters, and post-admission procedures were analyzed. RESULTS In total 1,696 and 2,187 urologic visits (22.45% decrease) and 387 and 439 urologic urgent admissions (11.85% decrease) were reported in given periods in 2020 and 2019, respectively. The year-over-year difference in daily mean visits was clear (36.1 vs. 46.5; p < 0.001). Declines were seen in all complaints but device malfunction. In 2020 daily mean visits and admissions decreased from 40.9 and 9.6 before lockdowns to 30.9 (p < 0.001) and 6.9 (p = 0.001) after severe restrictions, respectively. There was a trend towards more negative laboratory parameter profiles in 2020, with patients who visited the EDs after severe restrictions having twice as high median levels of C-reactive protein (15.39 vs. 7.84, p = 0.03). CONCLUSIONS The observed declines in ED visits and admissions were apparent with the significant effect of national lockdowns. Our results indicate that some of the patients requiring urgent medical help did not appear at the ED or came later than they would have done before the pandemic, presenting with more severe complaints.
Collapse
Affiliation(s)
- Pawel Rajwa
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Mikolaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Krajewski
- Department of Urology and Urological Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Blazej Kuffel
- Department of General and Oncological Urology, 1 University Hospital, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Piotr Zapala
- Department of General, Oncological and Functional Oncology, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Krzywon
- Department of Biostatistics and Bioinformatics, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Alexander J. Cortez
- Department of Biostatistics and Bioinformatics, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Bartosz Dybowski
- Department of Urology, Roefler Memorial Hospital, Pruszkow, Poland
| | - Remigiusz Stamirowski
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Marcin Jarzemski
- Department of Urology, Jan Biziel University Hospital in Bydgoszcz, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, Poland
| | - Rafal B. Drobot
- Department of Urology and Urological Oncology, Multidisciplinary Hospital in Warsaw-Miedzylesie, Warsaw, Poland
| | - Pawel Stelmach
- Clinical Department of Urology, 4 Clinical Military Hospital, Wroclaw, Poland
- Division of Oncology and Palliative Care, Faculty of Health Sciences, Wroclaw Medical University, Poland
| | - Krystyna Mlynarek
- Urological Ward, Independent Public Health Care Unit, Voivodeship Specialised Hospital No. 3, Rybnik, Poland
| | - Mateusz Marcinek
- Department of Urology, FMS in Katowice, Medical University of Silesia, Katowice, Poland
| | - Maciej Przudzik
- University of Warmia and Mazury, Faculty of Medicine, Department of Urology, Olsztyn, Poland
| | - Wiktor Krawczyk
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Jakub Ryszawy
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Dominik Choragwicki
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Lukasz Zapala
- Department of General, Oncological and Functional Oncology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Lipa
- Department of Urology and Urological Oncology, Multidisciplinary Hospital in Warsaw-Miedzylesie, Warsaw, Poland
| | - Michal Pozniak
- Department of General and Oncological Urology, 1 University Hospital, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Dawid Janczak
- Clinical Department of Urology, 4 Clinical Military Hospital, Wroclaw, Poland
- Division of Oncology and Palliative Care, Faculty of Health Sciences, Wroclaw Medical University, Poland
| | - Szymon Słomian
- Urological Ward, Independent Public Health Care Unit, Voivodeship Specialised Hospital No. 3, Rybnik, Poland
| | - Jan Łaszkiewicz
- Department of Urology and Urological Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Marcel Nowak
- Department of Urology, FMS in Katowice, Medical University of Silesia, Katowice, Poland
| | - Marcin Miszczyk
- Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Marek Roslan
- University of Warmia and Mazury, Faculty of Medicine, Department of Urology, Olsztyn, Poland
| | - Michał Tkocz
- Department of Urology, FMS in Katowice, Medical University of Silesia, Katowice, Poland
| | - Romuald Zdrojowy
- Department of Urology and Urological Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Andrzej Potyka
- Urological Ward, Independent Public Health Care Unit, Voivodeship Specialised Hospital No. 3, Rybnik, Poland
| | - Tomasz Szydełko
- Department of Urology, Medical University of Silesia, Zabrze, Poland
- Division of Oncology and Palliative Care, Faculty of Health Sciences, Wroclaw Medical University, Poland
| | - Tomasz Drewa
- Department of General and Oncological Urology, 1 University Hospital, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Piotr Jarzemski
- Department of Urology, Jan Biziel University Hospital in Bydgoszcz, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, Poland
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Oncology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Slojewski
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Artur Antoniewicz
- Department of Urology and Urological Oncology, Multidisciplinary Hospital in Warsaw-Miedzylesie, Warsaw, Poland
| | - Andrzej Paradysz
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Piotr L. Chlosta
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
20
|
The Use of Medical and Non-Medical Services by the Elderly during the SARS-CoV-2 Pandemic Differs between General and Specialist Practice: A One-Center Study in Poland. Healthcare (Basel) 2020; 9:healthcare9010008. [PMID: 33374828 PMCID: PMC7824705 DOI: 10.3390/healthcare9010008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 02/07/2023] Open
Abstract
In Poland, there is a lack of documented data on the use of medical and non-medical services by the elderly during the SARS-CoV-2 pandemic. The FIMA questionnaire assesses the use of medical and non-medical services by the elderly. The authors compared the demand for these services during the ongoing pandemic with similar months in 2017. It was confirmed that in the group of 61 surveyed elderly people, the number of individuals who had a medical visit decreased significantly in the three-month period. In the analyzed pandemic period, patients had significantly fewer visits to their general practitioner only. The pandemic had no significant impact on the use of other medical and non-medical services analyzed by FIMA. The limitations may include the small number of respondents, the relatively short period from the beginning of the pandemic covered by the survey, and the nature of the studied patients’ diseases. Further observation of elderly patients’ access to the abovementioned services can improve the efforts of governments and caregivers in this field, which is of particular importance in the group of chronically ill elderly patients.
Collapse
|
21
|
The number of obstructive colorectal cancers in Japan has increased during the COVID-19 pandemic: A retrospective single-center cohort study. Ann Med Surg (Lond) 2020; 60:675-679. [PMID: 33282280 PMCID: PMC7708825 DOI: 10.1016/j.amsu.2020.11.087] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 12/14/2022] Open
Abstract
Background The global pandemic of COVID-19 has changed cancer treatment environments. In Japan, cancer screenings were halted and the numbers of endoscopies and surgeries were restricted in some hospitals based on the state of emergency declared. Herein, we investigated the impact of the COVID-19 pandemic on the characteristics of colorectal cancer (CRC) patients in facilities that are on the frontline of both COVID-19 and cancer treatments. Patients and methods We retrospectively analyzed the cases of all of the CRC patients (n = 123) who underwent surgery at our regional cancer treatment center and tertiary emergency hospital in Japan during a 120-day period ranging from before to after the state of emergency declaration. CRC patients during the corresponding period in the previous year were also examined. Results Although the number of CRC patients did not show a significant change related to the pandemic, the incidence of obstructive CRCs significantly increased after the pandemic's start. The numbers of outpatients and colonoscopies both decreased, which could have resulted in the decrease of CRC patients detected by cancer screening during the pandemic. The numbers of symptomatic CRC patients and emergency admissions both increased significantly during the pandemic. Conclusion Our findings indicate the possibility that the discovery of CRCs in patients could be delayed due to the halt in screenings caused by the COVID-19 pandemic, resulting in the increase of obstructive CRCs. These results highlight the importance of cancer screening and suggest that the screening system for cancers should be reorganized before future pandemics. The proportion of obstructive CRC patients increased during the COVID-19 pandemic. During the COVID-19 pandemic, CRC patients were mainly detected by abdominal symptoms but not by cancer screening. It is possible that the delays in the detection and surgeries due to halted screenings promoted the CRC progression. The screening systems for cancer should be reorganize before a future pandemic of unknown infectious disease.
Collapse
|
22
|
Heijkoop B, Galiabovitch E, York N, Webb D. Consensus of multiple national guidelines: agreed strategies for initial stone management during COVID-19. World J Urol 2020; 39:3161-3174. [PMID: 33226444 PMCID: PMC7681178 DOI: 10.1007/s00345-020-03491-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/07/2020] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To review the existing available information regarding urolithiasis management and the impact of COVID-19 on this, and propose recommendations for management of emergency urolithiasis presentations in the COVID-19 era. METHODS Review of published guidelines produced by Urological Governing Bodies, followed by the literature review regarding urolithiasis management during the COVID-19 pandemic. RESULTS Consistent recommendations across guidelines and literature were that urolithiasis with concurrent sepsis or renal failure remains a urological emergency warranting urgent intervention within the pandemic environment. Ureteric stenting and percutaneous nephrostomy are considered equivalent for decompression in this setting, with both ideally to be performed under local anaesthesia where possible to spare ventilators and reduce aerosol-generating procedures. Greater utilization of medical expulsive therapy and dissolution chemolysis may occur during the pandemic, and longer indwelling stent times may be accepted while definite stone clearance is deferred. CONCLUSIONS Urolithiasis will continue to be a source of emergency presentations requiring urgent intervention during the COVID-19 pandemic. However, it is possible to limit these interventions to decompression of the collecting system in the setting of concurrent obstruction or infection, performed under local anaesthesia to limit use of resources and minimise aerosol-generating procedures, with deferral of definitive management.
Collapse
Affiliation(s)
- B Heijkoop
- Austin Health, The University of Adelaide, Heidelberg, VIC, Australia.
| | - E Galiabovitch
- Austin Health, The University of Adelaide, Heidelberg, VIC, Australia
| | - N York
- Auckland Regional Urology Service, Auckland, New Zealand
| | - D Webb
- Austin Health, The University of Adelaide, Heidelberg, VIC, Australia
| |
Collapse
|
23
|
Vissio E, Falco EC, Collemi G, Borella F, Papotti M, Scarmozzino A, Cassoni P, Bertero L. Impact of COVID-19 lockdown measures on oncological surgical activity: Analysis of the surgical pathology caseload of a tertiary referral hospital in Northwestern Italy. J Surg Oncol 2020; 123:24-31. [PMID: 33084056 DOI: 10.1002/jso.26256] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Italy was severely affected by the severe acute respiratory syndrome coronavirus 2 pandemic. Our Institution, Piedmont's largest tertiary referral center, was designated as a non-COVID-19 hospital and activities were reorganized to prioritize critical services like oncological care. The aim of this study was to investigate the efficacy in preserving the oncological surgical practice at our Institution during the most critical months of the COVID-19 epidemic by analyzing the surgical pathology activity. METHODS The number of oncological surgical resections submitted to histopathological examination from 9th March 2020 to 8th May 2020 were collected as well staging/grading data and compared with the previous three pre-COVID-19 years (2017-2019). RESULTS Overall, no decrease was observed for most tumor sites (5/9) while breast resections showed the largest drop (109 vs. 160; -31.9%), although a full recovery was already noticed during the second half of the period. Conversely, the selected control benchmarks showed a sharp decrease (-80.4%). Distribution of pathological TNM stages (or tumor grades for central nervous system tumors) showed no significant differences during the lockdown compared with previous years (p > .05). CONCLUSIONS The present data suggest the possibility of preserving this cornerstone oncological activity during an evolving public health emergency thanks to a prompt workflow reorganization.
Collapse
Affiliation(s)
- Elena Vissio
- Pathology Unit, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" University Hospital, University of Turin, Turin, Italy
| | - Enrico Costantino Falco
- Pathology Unit, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" University Hospital, University of Turin, Turin, Italy
| | - Giammarco Collemi
- Pathology Unit, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" University Hospital, University of Turin, Turin, Italy
| | - Fulvio Borella
- Obstetrics, and Gynecology Unit, Department of Surgical Sciences, Sant'Anna Hospital, "Città della Salute e della Scienza di Torino" University Hospital, University of Turin, Turin, Italy
| | - Mauro Papotti
- Pathology Unit, Department of Oncology, "Città della Salute e della Scienza di Torino" University Hospital, University of Turin, Turin, Italy
| | - Antonio Scarmozzino
- Healthcare Management, "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" University Hospital, University of Turin, Turin, Italy
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" University Hospital, University of Turin, Turin, Italy
| |
Collapse
|
24
|
The impact of the COVID-19 pandemic on pediatric operations: a retrospective study of Chinese children. Ital J Pediatr 2020; 46:155. [PMID: 33066803 PMCID: PMC7563908 DOI: 10.1186/s13052-020-00915-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/02/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The aim of this study was to quantify the impact of coronavirus disease 2019 (COVID-19) on pediatric operations, and establish preoperative, intraoperative, and postoperative protocols to improve the pediatric operations. METHODS We here compare the number of patients who underwent surgery in Chongqing Medical University Affiliated Children's Hospital during the pandemic (January 23-March 11), after the pandemic (March 12-April 30), after our measures were put in place (May 1-May 21), and the equivalent period in 2019. RESULT During the COVID-19 pandemic, 62.68% fewer patients underwent surgery than during the homologous period of time 1 year earlier (P < 0.01). After the COVID-19 pandemic, the number of orchidopexy cases increased significantly from 175.14 to 504.57 per week (P < 0.01). The large number of patients that accrued in our hospital may have increased the risk of COVID-19 transmission. In response, hospitals and clinics have made protocols and reorganized healthcare facilities (e.g., performing nucleic acid tests (NAT), adding adequate personal protective equipment (PPE)) from May 1, 2020. After the measures were implemented, the number of operations performed remained stable and comparable to the pre-pandemic period. COVID-19 RNA detection was performed in 5104 cases and there were no new confirmed cases in our hospital. CONCLUSION This outbreak of COVID-19 has affected not only individuals with COVID-19 but also patients seeking surgical operations. Understanding the present situation helps clinicians provide a high level of treatment to all children.
Collapse
|
25
|
Deferring Elective Urologic Surgery During the COVID-19 Pandemic: The Patients' Perspective. Urology 2020; 147:21-26. [PMID: 32979378 PMCID: PMC7513799 DOI: 10.1016/j.urology.2020.09.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/28/2020] [Accepted: 09/13/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To explore the perspective of urological patients on the possibility to defer elective surgery due to the fear of contracting COVID-19. METHODS All patients scheduled for elective urological procedures for malignant or benign diseases at 2 high-volume centers were administered a questionnaire, through structured telephone interviews, between April 24 and 27, 2020. The questionnaire included 3 questions: (1) In light of the COVID-19 pandemic, would you defer the planned surgical intervention? (2) If yes, when would you be willing to undergo surgery? (3) What do you consider potentially more harmful for your health: the risk of contracting COVID-19 during hospitalization or the potential consequences of delaying surgical treatment? RESULTS Overall, 332 patients were included (51.5% and 48.5% in the oncology and benign groups, respectively). Of these, 47.9% patients would have deferred the planned intervention (33.3% vs 63.4%; P < .001), while the proportion of patients who would have preferred to delay surgery for more than 6 months was comparable between the groups (87% vs 80%). These answers were influenced by patient age and American Society of Anesthesiologists score (in the Oncology group) and by the underlying urological condition (in the benign group). Finally, 182 (54.8%) patients considered the risk of COVID-19 potentially more harmful than the risk of delaying surgery (37% vs 73%; P < .001). This answer was driven by patient age and the underlying disease in both groups. CONCLUSIONS Our findings reinforce the importance of shared decision-making before urological surgery, leveraging patients' values and expectations to refine the paradigm of evidence-based medicine during the COVID-19 pandemic and beyond.
Collapse
|
26
|
McLean RC, Young J, Musbahi A, Lee JX, Hidayat H, Abdalla N, Chowdhury S, Baker EA, Etherson KJ. A single-centre observational cohort study to evaluate volume and severity of emergency general surgery admissions during the COVID-19 pandemic: Is there a "lockdown" effect? Int J Surg 2020; 83:259-266. [PMID: 32931980 PMCID: PMC7486821 DOI: 10.1016/j.ijsu.2020.09.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/08/2020] [Accepted: 09/05/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has led to changes in NHS surgical service provision, including reduced elective surgical and endoscopic activity, with only essential emergency surgery being undertaken. This, combined with the government-imposed lockdown, may have impacted on patient attendance, severity of surgical disease, and outcomes. The aim of this study was to investigate a possible 'lockdown' effect on the volume and severity of surgical admissions and their outcomes. METHODS Two separate cohorts of adult emergency general surgery inpatient admissions 30 days immediately before (February 16, 2020 to March 15, 2020), and after UK government advice (March 16, 2020 to April 15, 2020). Data were collected relating to patient characteristics, severity of disease, clinical outcomes, and compared between these groups. RESULTS Following lockdown, a significant reduction in median daily admissions from 7 to 3 per day (p < 0.001) was observed. Post-lockdown patients were significantly older, frailer with higher inflammatory indices and rates of acute kidney injury, and also were significantly more likely to present with gastrointestinal cancer, obstruction, and perforation. Patients had significantly higher rates of Clavien-Dindo Grade ≥3 complications (p = 0.001), all cause 30-day mortality (8.5% vs. 2.9%, p = 0.028), but no significant difference was observed in operative 30-day mortality. CONCLUSION There appears to be a "lockdown" effect on general surgical admissions with a profound impact; fewer surgical admissions, more acutely unwell surgical patients, and an increase in all cause 30-day mortality. Patients should be advised to present promptly with gastrointestinal symptoms, and this should be reinforced for future lockdowns during the pandemic.
Collapse
Affiliation(s)
- Ross C McLean
- Department of Colorectal Surgery, University Hospital of North Tees, Hardwick Road, Stockton-On-Tees, TS19 8PE, UK
| | - John Young
- Department of Colorectal Surgery, University Hospital of North Tees, Hardwick Road, Stockton-On-Tees, TS19 8PE, UK
| | - Aya Musbahi
- Department of Colorectal Surgery, University Hospital of North Tees, Hardwick Road, Stockton-On-Tees, TS19 8PE, UK
| | - Jing Xian Lee
- Department of Colorectal Surgery, University Hospital of North Tees, Hardwick Road, Stockton-On-Tees, TS19 8PE, UK
| | - Hena Hidayat
- Department of Colorectal Surgery, University Hospital of North Tees, Hardwick Road, Stockton-On-Tees, TS19 8PE, UK
| | - Nagi Abdalla
- Department of Colorectal Surgery, University Hospital of North Tees, Hardwick Road, Stockton-On-Tees, TS19 8PE, UK
| | - Sabyasachi Chowdhury
- Department of Colorectal Surgery, University Hospital of North Tees, Hardwick Road, Stockton-On-Tees, TS19 8PE, UK
| | - Elizabeth A Baker
- Department of Colorectal Surgery, University Hospital of North Tees, Hardwick Road, Stockton-On-Tees, TS19 8PE, UK
| | - Kevin Jon Etherson
- Department of Colorectal Surgery, University Hospital of North Tees, Hardwick Road, Stockton-On-Tees, TS19 8PE, UK.
| |
Collapse
|
27
|
Karabulut I, Cinislioglu AE, Cinislioglu N, Yilmazel FK, Utlu M, Alay H, Celik EC, Adanur S. The Effect of the Presence of Lower Urinary System Symptoms on the Prognosis of COVID-19: Preliminary Results of a Prospective Study. Urol Int 2020; 104:853-858. [PMID: 32894859 PMCID: PMC7573898 DOI: 10.1159/000510761] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 08/06/2020] [Indexed: 01/08/2023]
Abstract
Purpose To investigate the effectiveness of benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS), which occur as a natural result of aging and androgen exposure, in predicting disease prognosis in male patients diagnosed with COVID-19. Methods The study was planned prospectively. The study included 63 male patients over 40 years of age diagnosed with COVID-19. The patients were diagnosed with COVID-19 based on the results of reverse transcription polymerase chain reaction tests of oropharyngeal and nasopharyngeal swabs obtained as per the World Health Organization guidelines. The presence of LUTS was assessed by the International Prostate Symptom Score (I-PSS), a subjective assessment, and the I-PSS was filled for the patients included in the study. The patients were divided into three groups based on their scores in the I-PSS survey: group 1: mild (0–7), group 2: moderate (8–19), and group 3: severe (20–35). The data of all three groups were statistically analyzed. Results In the assessment performed between the groups, it was identified that for patients in group 3, the length of hospital stay was longer, intensive care requirement was more frequent, and their mortality rates were numerically higher. In the evaluation made regarding the time to intensive care admittance, this was identified to be the shortest in group 3. Conclusion As a result of our study, we think that in patients with COVID-19, BPH-related LUTS can guide clinicians in predicting prognosis.
Collapse
Affiliation(s)
- Ibrahim Karabulut
- Department of Urology, Health Sciences University Regional Training and Research Hospital, Erzurum, Turkey
| | - Ahmet Emre Cinislioglu
- Department of Urology, Health Sciences University Regional Training and Research Hospital, Erzurum, Turkey,
| | - Nazan Cinislioglu
- Department of Infectious Diseases and Clinical Microbiology, Ataturk University Medical Faculty, Erzurum, Turkey
| | - Fatih Kursat Yilmazel
- Department of Urology, Health Sciences University Regional Training and Research Hospital, Erzurum, Turkey
| | - Mustafa Utlu
- Department of Internal Medicine, Health Sciences University Regional Training and Research Hospital, Erzurum, Turkey
| | - Handan Alay
- Department of Infectious Diseases and Clinical Microbiology, Ataturk University Medical Faculty, Erzurum, Turkey
| | - Erkan Cem Celik
- Department of Anesthesiology and Reanimation, Ataturk University Medical Faculty, Erzurum, Turkey
| | - Senol Adanur
- Department of Urology, Ataturk University Medical Faculty, Erzurum, Turkey
| |
Collapse
|
28
|
Truong T, Dittmar M, Ghaffari A, Lin E. Policy and Pandemic: The Changing Practice of Nephrology During the Coronavirus Disease-2019 Outbreak. Adv Chronic Kidney Dis 2020; 27:390-396. [PMID: 33308504 PMCID: PMC7311906 DOI: 10.1053/j.ackd.2020.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023]
Abstract
The coronavirus (coronavirus disease-2019) pandemic has changed care delivery for patients with end-stage kidney disease. We explore the US healthcare system as it pertains to dialysis care, including existing policies, modifications implemented in response to the coronavirus disease-2019 crisis, and possible next steps for policy makers and nephrologists. This includes policies related to resource management, use of telemedicine, prioritization of dialysis access procedures, expansion of home dialysis modalities, administrative duties, and quality assessment. The government has already established policies that have instated some flexibilities to help providers focus their response to the crisis. However, future policy during and after the coronavirus disease-2019 pandemic can bolster our ability to optimize care for patients with end-stage kidney disease. Key themes in this perspective are the importance of policy flexibility, clear strategies for emergency preparedness, and robust health systems that maximize accessibility and patient autonomy.
Collapse
|
29
|
Verze P, Cai T, Malossini G, Bjerklund Johansen TE, Baio R, Palmieri A. When technological innovations do not reach consensus: the case of tele-consultation of andrological patients. Int J Impot Res 2020; 33:660-662. [PMID: 32843710 PMCID: PMC7445819 DOI: 10.1038/s41443-020-00348-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/13/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Paolo Verze
- Department of Medicine, Surgery, Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy.
| | - Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gianni Malossini
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
| | - Truls E Bjerklund Johansen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Urology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Raffaele Baio
- Department of Medicine, Surgery, Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Alessandro Palmieri
- Department of Neurosciences, Reproductive Sciences, Odontostomatology, University of Naples "Federico II", Naples, Italy
| |
Collapse
|