Self-reported Mental Health Measures among Incoming Collegiate Student-Athletes who had SARS-COVID-19.

BACKGROUND: COVID-19 survivors may experience persistent neuropsychological disruptions such as lower satisfaction with life (SWLS), depression, and anxiety. While student-athletes are at low risk for severe COVID complications, the effect of COVID on mental health remains to be elucidated. OBJECTIVE: Compare patient-reported mental health outcomes for incoming collegiate athletes who did (COVID+) and did not (COVID-) have COVID-19. METHODS: 79 COVID+ (79/178, 44.4%, 18.90±0.16 years) and 99 COVID- (99/178, 55.6%,18.95±0.16 years) completed SWLS, anxiety (HADS anxiety, STAI), depression (HADS depression). Unadjusted One-way ANOVAs were conducted across all patient-reported outcomes. ANCOVAs were conducted to determine the interaction of COVID history, sex, and race/ethnicity on outcomes. Post-hoc Bonferroni testing was performed to determine specific differences between groups. Chi-square analyses were used to compare the number of athletes who met the standard of clinical cut points for both groups. RESULTS: We observed a significant difference between groups for HADS depression (p=0.047), whereby athletes in the COVID+ group had significantly higher depression ratings (2.9±0.3). There was a significant group difference for SWLS (p=0.019), HADS anxiety (p=0.003), and STAI state anxiety (p=0.014) such that SWLS, HADS anxiety, and trait anxiety was higher for the COVID+ group in the adjusted model. Post-hoc testing revealed that COVID+ females had significantly worse HADS anxiety (p=0.011) and STAI trait anxiety (p=0.002). There were no significant differences in the percentage of responses below established diagnostic thresholds between groups. CONCLUSIONS: Incoming collegiate student-athletes who reported prior COVID diagnosis reported significantly higher depression scores suggesting clinicians may need to be aware of the potential need to intervene with appropriate mental health identification and referral. However, it was encouraging that most participants, regardless of prior COVID diagnosis, had mental health scores that did not exceed established diagnostic threshold values.

Changes in urologic operative practice at the beginning of the COVID-19 pandemic in a large, national cohort

INTRODUCTION AND OBJECTIVE: While subject to frequent speculation, the actual impact of the COVID-19 pandemic on urologic operative practice is unknown. Understanding the consequences of the pandemic will teach invaluable lessons for future preparedness and provide useful context for individual practices attempting to understand changes in operative volume. We analyzed populationlevel changes in operative practice since the onset of the COVID-19 pandemic to contextualize observations made by individual practices and optimize future responses. METHODS: We used Premier Perspectives Database to investigate changes in operative volume through March 2020. Baseline operative volume for urologic surgery was calculated using data from the preceding 12 months and compared on a total and by procedure basis. Multivariable linear regression was used to identify hospital-level predictors of change in response to the pandemic. Our primary outcome of interest was the change in operative volume in March 2020 relative to baseline. Total operative volume, and volume by procedure and procedure-based groupings were investigated. RESULTS: At baseline, we captured 23,788 urologic procedural encounters per month as compared with 19,071 during March 2020e a 19.9% decrease. Urologic oncology-related cases were relatively preserved as compared to others (average change in March 2020: =1.1% versus -32.2%). Northeastern (b=-5.66, 95% confidence interval [CI]: -10.2 to -1.18, p=.013) and Midwestern hospitals (b=-4.17, 95% CI: -7.89 to -0.45, p=.027;both with South as reference region), and those with an increasing percentage of patients insured by Medicaid (b= -.17 per percentage point, 95% CI: -.33 to -.01, p=.04) experienced a significantly larger decrease in volume. CONCLUSIONS: There was a 20% decline in urologic operative volume in March 2020, compared with baseline, that preferentially affected hospitals serving Medicaid patients, and those in the Northeast and Midwest. In the face of varying mandates on elective surgery, widespread declines in operative volume may also represent hesitancy on behalf of patients to interface with healthcare during the pandemic. Long-term follow-up will be necessary to determine COVID-19's final toll on urology.