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Applicability of COVID-19 Pandemic Recommendations for Urology Practice: Data from Three Major Italian Hot Spots
Paolo Dell'Oglio1,2,3, Giovanni Enrico Cacciamani4, Fabio Muttin5
1Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Insights
The COVID-19 pandemic significantly reduced urologic activities in Lombardy, Italy. Recommendations for high-priority surgeries require adaptation based on hospital capacity and local disease incidence.
Area of Science:
- Urology
- Public Health
- Infectious Diseases
Background:
- Lombardy, Italy, was severely impacted by the initial waves of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
- The study focuses on the impact of coronavirus disease 2019 (COVID-19) on urologic activities in a highly affected region.
Purpose of the Study:
- To evaluate the effect of COVID-19 on all urologic activities over 17 weeks in Lombardy's largest public hospitals.
- To assess the applicability of official recommendations for reorganizing urology practice during the pandemic.
Main Methods:
- Retrospective analysis of urologic activities in three major Lombardy hospitals (January 1 - April 28, 2020).
- Join-point regression used to identify trends in urologic activities.
- Uro-oncologic surgeries were stratified based on expert recommendations (Stensland et al.) and European Association of Urology guidelines.
Main Results:
- A consistent decrease in urologic activities was observed from weeks 8-9 to 11-13 (Average Weekly Percentage Change: -41% to -29.9%).
- One-third of uro-oncologic surgeries performed were potentially postponable according to preliminary recommendations.
- High applicability of recommendations was noted for specific cancer types (e.g., penile, testicular, intermediate-risk NMIBC, UTUC, RCC), while low applicability was seen for others (e.g., low/high-risk NMIBC, high-risk UTUC, intermediate/high-risk prostate cancer).
Conclusions:
- The COVID-19 pandemic led to a significant reduction in overall urologic activities.
- Adaptation of high-priority surgery recommendations is necessary, considering hospital resources and local pandemic severity.
- Expert recommendations for urologic care during pandemics should be flexible and tailored to specific hospital capacities and regional conditions.
Background:
Lombardy has been the first and one of the most affected European regions during the first and second waves of the novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]).
Objective:
To evaluate the impact of coronavirus disease 2019 (COVID-19) on all urologic activities over a 17-wk period in the three largest public hospitals in Lombardy located in the worst hit area in Italy, and to assess the applicability of the authorities' recommendations provided for reorganising urology practice.
Design Setting And Participants:
A retrospective analysis of all urologic activities performed at three major public hospitals in Lombardy (Brescia, Bergamo, and Milan), from January 1 to April 28, 2020, was performed.
Outcome Measurements And Statistical Analysis:
Join-point regression was used to identify significant changes in trends for all urologic activities. Average weekly percentage changes (AWPCs) were estimated to summarise linear trends. Uro-oncologic surgeries performed during the pandemic were tabulated and stratified according to the first preliminary recommendations by Stensland et al (Stensland KD, Morgan TM, Moinzadeh A, et al. Considerations in the triage of urologic surgeries during the COVID-19 pandemic. Eur Urol 2020;77:663-6) and according to the level of priority recommended by European Association of Urology guidelines.
Results And Limitations:
The trend for 2020 urologic activities decreased constantly from weeks 8-9 up to weeks 11-13 (AWPC range -41%, -29.9%; p < 0.001). One-third of uro-oncologic surgeries performed were treatments that could have been postponed, according to the preliminary urologic recommendations. High applicability to recommendations was observed for non-muscle-invasive bladder cancer (NMIBC) patients with intermediate/emergency level of priority, penile and testicular cancer patients, and upper tract urothelial cell carcinoma (UTUC) and renal cell carcinoma (RCC) patients with intermediate level of priority. Low applicability was observed for NMIBC patients with low/high level of priority, UTUC patients with high level of priority, prostate cancer patients with intermediate/high level of priority, and RCC patients with low level of priority.
Conclusions:
During COVID-19, we found a reduction in all urologic activities. High-priority surgeries and timing of treatment recommended by the authorities require adaptation according to hospital resources and local incidence.
Patient Summary:
We assessed the urologic surgeries that were privileged during the first wave of coronavirus disease 2019 (COVID-19) in the three largest public hospitals in Lombardy, worst hit by the pandemic, to evaluate whether high-priority surgeries and timing of treatment recommended by the authorities are applicable. Pandemic recommendations provided by experts should be tailored according to hospital capacity and different levels of the pandemic.
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