Perioperative outcomes of patients undergoing urological elective surgery during the COVID-19 pandemic: a national overview across 28 Italian institutions

April 2021

Central European Journal of Urology

DOI: 10.5173/ceju.2021.0374

Authors

Andrea Minervini, Fabrizio Di Maida, Andrea Mari, Angelo Porreca, Bernardo Rocco, Antonio Celia, Pierluigi Bove, Paolo Umari, Alessandro Volpe, Antonio Galfano,
Antonio Luigi Pastore, Filippo Annino, Paolo Parma, Francesco Greco, Roberto Nucciotti, Riccardo Schiavina, Fabio Esposito, Daniele Romagnoli, Costantino Leonardo, Roberto Falabella, Fabrizio Gallo, Michele Amenta, Carmine Sciorio, Paolo Verze, Alessandro Tafuri, Luigi Pucci, Virginia Varca, Stefano Zaramella, Vincenzo Pagliarulo, Giorgio Bozzini, Carlo Ceruti, Mario Falsaperla, Angelo Cafarelli, Alessandro Antonelli

Collaborators

Daniele D’Agostino, Maria Chiara Sighinolfi, Tommaso Silvestri, Valerio Iacovelli, Paolo Dell’Oglio, Andrea Fuschi, Riccardo Tellini, Giacomo Pirola, Mattia Nidini, Vincenzo M. Altieri, Lorenzo Bianchi, Antonio Tufano, Saveriano Lioi, Maurizio Schenone, Luca Lambertini, Alfio Corsaro, Lorenzo Spirito, Raffaele Baio, Paolo Fedelini, Dario Ratti, Nicolò Testino, Rita De Mitri, Alberto Calori, Marco Oderda, Giulio Bonvissuto, Donato Dente, Alessandra Gozzo, Katia Odorizzi

Abstract

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.

A pneumonia of undefined etiology, first detected in Wuhan, China, was reported by the World Health Organization (WHO) Country Office on 31 Decem- ber 2019 [1]. Soon thereafter a new coronavirus was identified as the causative agent and the International Committee on Taxonomy of Viruses named the virus as ‘acute severe respiratory syndrome coronavirus 2’ (SARS-CoV-2) with the related respirato- ry corona virus disease (COVID-19) [2].

The COVID-19 pandemic has unequivocally brought unique challenges to the global healthcare community [3, 4, 5]. Public health guidance tried to face the overwhelming impact of the virus using the best available scientific evidence to properly inform and guide decision makers involved in the management of the pandemic [6]. Most eminent international scientific committees released recommendations for prioritizing urgent and time-sensitive surgical procedures, despite having limited and flawed supporting evidence. As a result, surgical departments have thoughtfully reviewed all scheduled procedures to minimize or postpone elective surgery so that the health care centres could eventually support a rapid increase in critical patient care needs [7–10].

We currently acknowledge paucity of data regarding perioperative outcomes of patients undergoing

elective surgery during the COVID-19 pandemic [11, 12]. Indeed, the progressively growing need of assistance for COVID-19 patients will lead to fewer resources and personnel for patients seeking care for other conditions [13, 14]. Moreover, in the hypothesis of a further reduction of elective surgical activity, ethical concerns would be raised especially in the setting of oncological surgery [15–19]. Last but not least, assuming a long-lasting pandemic, we truly need strong evidence to assess safety of performing surgical procedures also for benign pathology [20].

In this light, a better understanding of the real im- pact of the pandemic on urological surgery and the associated perioperative outcomes represents a key unmet need and could lead towards an in-depth knowledge of the pandemic for a proper rationalization of human and logistic resources. Furthermore, we do believe our findings might eventually be transposed to other surgical specialties.

To address these needs, we retrospectively reviewed our prospectively collected clinical and surgical data of patients undergoing different types of elective urological procedures during the COVID-19 pandemic in 28 different institutions across Italy. The aim of this study was to assess the safety of elective 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.