Surgical activity in the COV1D-19 era: trend of slowdown from a multicentre observational study

ABSTRACT

Introduction: COVID-19 outbreak represented an unprecedented event that led to a redefinition of health care systems worldwide. The impact of the emergency required a deviation of the care toward the assistance to COVID-19 patients, with reduction of resources for elective activities, including surgery. We aim to report the decrease of urological surgical activity during the first weeks from the beginning of the pandemic, aiming to highlight the prioritization we applied to select patients for surgery. Materials and methods: Thirty-three urological units with physicians affiliated to the AGILE group were involved in a survey. Urologists were asked to report the amount of surgical elective procedures week- by-week, from the beginning of the emergency to the following month. The type of surgery (oncologic, for urolithiasis, for benign prostate obstruction, other) was assessed as well. Results: The 33 hospitals involved in the study account, globally, for 22,945 beds and are distributed in 13/20 Italian regions. Before the outbreak, the involved urology units performed an overall amount of 1,213 procedures per week, half of which were oncological. By the 20 of March, the amount of surgery declined by 78%. Lombardy, the first region with positive-cases, experienced a 94% reduction. The decrease in oncological and non- oncological surgical activity was 35,9% and 89%, respectively. Among non-oncological procedures, stone surgery declined by 35,9% as well, whereas BPH and minor urological procedures completely dropped. Reassessing for surgical activity on 20, April, a slight trend toward surgical restoration (+11%) started to appear. Conclusions: Italy, the country with the highest fatality rate from COVID-19, had experienced a sudden decline in surgical activity;by the end of April, a current trend toward restoration of surgery started to appear. Criteria for prioritization were consistent with an urgent/ emergent principle, with trauma, tumours and septic conditions being the ones prioritized. The Italian experience can be helpful for future surgical pre-planning in other countries or pandemic settings. Smart Communications (SC1–SC28) Andrology