ABSTRACT
INTRODUCTION AND OBJECTIVE: The SARS-CoV-2 (COVID) pandemic threatened access to healthcare, raising concerns that patients were going underdiagnosed and undertreated. The aim of our study was to understand the impact of the COVID pandemic on diagnosis and surgical management of common urological conditions. METHODS: Using a large multi-center electronic health record network (TRINETx) consisting of 46 healthcare organizations, we conducted an epidemiological study investigating the number of patients newly diagnosed with common urological conditions and those undergoing urologic surgeries at yearly intervals from March 1st, 2016 to March 1st, 2021. Relevant international classification of diseases (ICD) codes used to identify urologic conditions are elaborated on in Table 1. Current procedural terminology (CPT) codes used to identify surgeries are detailed in Figure 1. We then determined the percentage of newly diagnosed patients who underwent surgery for each specific year. RESULTS: We saw a decrease in number of all urologic surgeries being performed during the initial year of the pandemic (Figure 1). From March 2020-2021, there was a >20% decrease in surgical case load for benign prostatic hyperplasia procedures (-29.5%), prostate biopsies (-30.1%), incontinence procedures (-33.6%), and vasectomies (-22.8%), compared to the preceding year. Radical cystectomies and orchiectomies saw the lowest decrease, -5.9% and -8.6%, respectively. A similar trend was seen in the number of individuals newly diagnosed with urologic conditions and percentage of patients undergoing surgical intervention. The lowest drops were seen with ureteral stent placements (-5.0%) and prostate biopsies (-3.1%). CONCLUSIONS: The number of people receiving urologic diagnoses and surgical case load for urologic procedures significantly reduced during the first year of the COVID pandemic. Providers should be aware of this healthcare disparity, and greater efforts made to identify these missed patients moving forward.
ABSTRACT
Introduction & Objective: Urologic-related visits to the emergency department (ED) are variable in their acuity, ranging from non-emergent to life-threatening. We sought to evaluate trends in urologic presentations to the ED during the COVID-19 pandemic at a tertiary academic institution in the United States to determine the differences in frequency between urgent and nonurgent visits and further elucidate delayed access to urologic care. Methods: A retrospective analysis was performed comparing the frequency and type of urologic-related ED visits at our institution in January-April 2019 to those in January-April 2020 during the initial pandemic phase. 1,838 urologic presentations between the two-time intervals were organized by diagnosis and divided by acuity into urgent and non-urgent categories. Interrupted time series regression models were used to determine how urologicrelated ED visits changed due to the COVID-19 pandemic. Results: The total number of urologic related ED visits by type for each time interval is demonstrated in Table 1. There was a statistically significant drop in total urologic-related ED visits after the COVID-19 pandemic began, with a drop in total visits of approximately 76 per month (p = 0.002). There was no difference in the number of urgent ED visits due to the COVID-19 pandemic (p = 0.13). However, there was a statistically significant decrease in non-urgent ED visits, with a decrease of 68 visits per month (p = 0.002). When examining the individual visit types, there were no differences in visit volume except for hematuria and nephrolithiasis/ureterolithiasis visits. There was a statistically significant reduction in hematuria-related ED visits, with a reduction in visits of approximately 11 per month (p = 0.03). Similarly, there was a statistically significant decline in nephrolithiasis/ ureterolithiasis-related ED visits, with a decline of approximately 28 visits per month (p = 0.04). Conclusions: The COVID-19 pandemic coincided with a significant decrease in the number of non-urgent urologic presentations to our institution's ED. Specifically, there was a significant decrease in the number of patients presenting with hematuria and nephrolithiasis-related issues. There was no significant decrease in the number of urgent urologic consults. Follow up study is indicated to investigate the effect of delayed evaluation for these non-urgent urologic diagnoses. (Table Presented).