ABSTRACT
Introduction During the beginning of the COVID-19 pandemic in our center, neither prehabilitation nor multimodal rehabilitation could be applied due to the excessive patient load on the health system and to reduce SARS-CoV-2 transmission. The objective of our study was to analyze the evolution, complications, and survival up to one year of patients who underwent radical cystectomy in our hospital from March 1st to May 31st, 2020 (period of the first wave COVID-19 pandemic in Spain). We also compared the results with cystectomized patients outside the pandemic period and with application of the ERAS (Enhanced Recovery After Surgery) protocol. Material and methods Single-center, retrospective cohort study of patients scheduled for radical cystectomy from March 1st, 2020 to May 31st, 2020. They were matched with previously operated patients using a 1:2 propensity matching score. The matching variables were demographic data, preoperative and intraoperative clinical conditions. Results A total of 23 radical cystectomies with urinary diversion were performed in the period described. In none of the cases the prehabilitation or the follow-up of our ERAS protocol could be applied, and this was the only difference we found between the 2 groups. Although the minimally invasive approach was more frequent in the pandemic group, the difference was not statistically significant. Three patients were diagnosed with COVID-19 during their admission, presenting severe respiratory complications and high in-hospital mortality. Apart from respiratory complications secondary to SARS-CoV-2, we also found statistically significant differences in other postoperative complications. The hospital stay increased by 3 days in the pandemic group. Conclusions Patients who underwent radical cystectomy at our center during the first wave of the COVID-19 pandemic had a higher number and severity of respiratory and non-respiratory complications. Discontinuation of the ERAS protocol was the main difference in treatment between groups.
ABSTRACT
INTRODUCTION: During the beginning of the COVID-19 pandemic in our center, neither prehabilitation nor multimodal rehabilitation could be applied due to the excessive patient load on the health system and to reduce SARS-CoV-2 transmission. The objective of our study was to analyze the evolution, complications, and survival up to one year of patients who underwent radical cystectomy in our hospital from March 1st to May 31st, 2020 (period of the first wave COVID-19 pandemic in Spain). We also compared the results with cystectomized patients outside the pandemic period and with application of the ERAS (Enhanced Recovery After Surgery) protocol. MATERIAL AND METHODS: Single-center, retrospective cohort study of patients scheduled for radical cystectomy from March 1st, 2020 to May 31st, 2020. They were matched with previously operated patients using a 1:2 propensity matching score. The matching variables were demographic data, preoperative and intraoperative clinical conditions. RESULTS: A total of 23 radical cystectomies with urinary diversion were performed in the period described. In none of the cases the prehabilitation or the follow-up of our ERAS protocol could be applied, and this was the only difference we found between the 2 groups. Although the minimally invasive approach was more frequent in the pandemic group, the difference was not statistically significant. Three patients were diagnosed with COVID-19 during their admission, presenting severe respiratory complications and high in-hospital mortality. Apart from respiratory complications secondary to SARS-CoV-2, we also found statistically significant differences in other postoperative complications. The hospital stay increased by 3 days in the pandemic group. CONCLUSIONS: Patients who underwent radical cystectomy at our center during the first wave of the COVID-19 pandemic had a higher number and severity of respiratory and non-respiratory complications. Discontinuation of the ERAS protocol was the main difference in treatment between groups.
Subject(s)
COVID-19 , Urinary Bladder Neoplasms , Humans , Cystectomy/methods , Pandemics , Retrospective Studies , Urinary Bladder Neoplasms/surgery , COVID-19/epidemiology , SARS-CoV-2ABSTRACT
INTRODUCTION: During the beginning of the COVID-19 pandemic in our center, neither prehabilitation nor multimodal rehabilitation could be applied due to the excessive patient load on the health system and to reduce SARS-CoV-2 transmission. The objective of our study was to analyze the evolution, complications, and survival up to one year of patients who underwent radical cystectomy in our hospital from March 1st to May 31st, 2020 (period of the first wave COVID-19 pandemic in Spain). We also compared the results with cystectomized patients outside the pandemic period and with application of the ERAS (Enhanced Recovery After Surgery) protocol. MATERIAL AND METHODS: Single-center, retrospective cohort study of patients scheduled for radical cystectomy from March 1st,2020 to May 31st, 2020. They were matched with previously operated patients using a 1:2 propensity matching score. The matching variables were demographic data, preoperative and intraoperative clinical conditions. RESULTS: A total of 23 radical cystectomies with urinary diversion were performed in the period described. In none of the cases the prehabilitation or the follow-up of our ERAS protocol could be applied, and this was the only difference we found between the 2 groups. Although the minimally invasive approach was more frequent in the pandemic group, the difference was not statistically significant. Three patients were diagnosed with COVID-19 during their admission, presenting severe respiratory complications and high in-hospital mortality. Apart from respiratory complications secondary to SARS-CoV-2, we also found statistically significant differences in other postoperative complications. The hospital stay increased by 3 days in the pandemic group. CONCLUSIONS: Patients who underwent radical cystectomy at our center during the first wave of the COVID-19 pandemic had a higher number and severity of respiratory and non-respiratory complications. Discontinuation of the ERAS protocol was the main difference in treatment between groups.
ABSTRACT
Introducción: Al inicio de la pandemia COVID-19 no se pudo implementar ni prehabilitación ni rehabilitación multimodal por sobrecarga del sistema sanitario. Nuestro objetivo fue analizar evolución, complicaciones y supervivencia hasta el año de pacientes sometidos a cistectomía radical en nuestro centro desde 1 de Marzo hasta 31 de Mayo de 2020 (primera ola). Comparamos resultados con pacientes también cistectomizados fuera de pandemia donde sí estaba instaurado el protocolo ERAS. Material y Métodos: Estudio de cohortes retrospectivo, unicéntrico, de pacientes programados para cistectomía radical desde 1 de marzo de 2020 hasta 31 de mayo de 2020;se emparejaron con pacientes intervenidos anteriormente a través de score de emparejamiento por propensión 1:2. Las variables de emparejamiento fueron datos demográficos, condiciones clínicas preoperatorias e intraoperatorias. Resultados: Se realizaron 23 cistectomía en este periodo;en ningún caso se aplicó ni prehabilitación ni seguimiento del protocolo ERAS, y ésta fue la única diferencia en el tratamiento entre grupos. Tres pacientes se diagnosticaron de COVID-19 durante su ingreso presentando complicaciones respiratorias graves y alta mortalidad intrahospitalaria. La tasa de transfusión sanguínea fue mayor en el grupo pandemia. La estancia hospitalaria aumentó en 3 días en grupo pandemia. Conclusiones: Los pacientes sometidos a cistectomía en nuestro centro durante la primera ola de pandemia COVID-19 presentaron complicaciones respiratorias y no respiratorias en mayor número y más graves que los cistectomizados fuera de este periodo. La no aplicación del protocolo ERAS fue la principal diferencia en el tratamiento entre grupos.
ABSTRACT
Objectives: During the onset of the COVID-19 pandemic, surgical activity decreased due to an overload of the health system and to reduce SARS-COV-2 transmission. The objective of our study was to evaluate characteristics, analyze complications and survival up to one year of patients who underwent radical cystectomy in our hospital from March 1 to May 31, 2020 (period of the first wave of the COVID-19 pandemic in Spain). We also compared the results with cystectomized patients enrolled in an ERAS program but outside the pandemic period. Method(s): Retrospective, single-center cohort study of patients scheduled for radical cystectomy from March 1, 2020 to May 31, 2020;they were matched with previously operated patients through propensity matching score 1:2. The matching variables were demographic data, preoperative and intraoperative clinical conditions. Result(s): A total of 23 radical cystectomies with urinary diversion were performed in the period described. The minimally invasive approach was more frequent in the pandemic group. Three patients were diagnosed with COVID-19 during their admission. We did not find statistically significant differences in postoperative complications or in mortality up to one year of follow-up. Conclusion(s): The first wave effect of the COVID-19 pandemic did not increase complications or mortality in patients who underwent radical cystectomy in our hospital, although a clear tendency was observed to have more and more severe complications. Performing the SARS-CoV-2 PCR test preoperatively was critical to control in-hospital transmission. The correct selection of surgical patients during the first wave was essential to optimize their evolution. References: 1. Guan W.J.Ni Z.Y,Hu Y.et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382: 1708-1720. 2. Ministerio de la Presidencia, Relaciones con las Cortes y Memoria Democratica. Real Decreto 463/2020, de 14 de marzo, por el que se declara el estado de alarma para la gestion de la situacion de crisis sanitaria ocasionada por el COVID-19. BOE no 67 de 14 de marzo de 2020. 2020;67(I):25390-400. 3. 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. Disclosure of Interest: None declared Copyright © 2022
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Background: MRI imaging biomarkers can non-invasively characterize liver tissue potentially allowing early diagnosis and treatment. Proton density fat fraction (PDFF), R2∗, and T1 and T2 times are relevant biomarkers measuring fat (PDFF), iron content (R2∗), inflammation, and fibrosis (T1, T2). This study takes advantage of the MRI screening program that was established at our institution for myocarditis in competitive athletes recovering from COVID-19. The purpose of this project was to establish hepatic reference values for these biomarkers for the specific population of young competitive adult athletes. Methods: This retrospective study was HIPAAcompliant and IRB approved. Clinical cardiac MRI exams of competitive student athletes recovering from COVID-19 acquired between 01/2020 and 04/2021 at 1.5T or 3T were screened. 3D confounder-corrected PDFF and R2∗ maps were obtained over the entire liver in the axial plane, while T1 and T2 maps obtained through the heart in the double oblique short axis view also visualized large portions of the left lobe of the liver. PDFF, R2∗, T1 and T2 Maps were analyzed with OsiriX (pixmeo SARL, Switzerland). In PDFF and R2∗ maps, the largest possible ROIs were placed in each Couinaud segment avoiding vessels, bile ducts, and artifacts. In T1 and T2 maps, the largest possible ROI was placed in each slice that included the liver. For each patient and map, the mean value of the liver ROIs was recorded. Results were compared between field strengths and sex using t-test. Results: 105 athletes matched the inclusion criteria (35 female, 19±1 years, BMI 26±5 kg/m). One patient was excluded due to clinical and imaging findings of COVID-associated myocarditis. 10 subjects had an elevated PDFF between 5.1% and 11.3%, one athlete had a mild iron overload (R2∗= 136 s-1 at 1.5T). Gender- and field strength-specific results are compiled in Table 1. PDFF, R2∗, and T1 values differed significantly between field strengths. T1 and T2 times differed significantly between gender at 3T and 1.5T, respectively. Conclusion: We generated gender- and field strength-specific reference values for hepatic T1, T2, PDFF and R2∗ in young athletes. Our results are consistent with published normal values for adults, with PDFF and T1 at the lower end of published values. The prevalence of pathologic hepatic fat and iron content was low. Significant differences in BMI and skewed gender distribution may limit the generalizability of our results. We will address this issue in a larger future study.