Urological cancer surgery during the first wave of the COVID-19 pandemic: analyses of short-term outcomes from the COVIDSurg-Cancer study

ABSTRACT

Introduction: The COVID-19 pandemic has disrupted surgical services. We aimed to assess 30-day post-operative outcomes following urological cancer surgery during the COVID-19 pandemic. Patients and Methods: All bladder, kidney, UTUC and prostate cancer patients from the COVIDSurg-Cancer Study who underwent elective, potentially-curative surgery during the COVID-19 pandemic until July 2020 were included. Univariable and multivariable logistic regression was performed to assess the association of patient factors with mortality, respiratory complications, and operative complications. Results: 1,902 patients from 36 countries were included. 42 (0.2%) patients were diagnosed with COVID-19 during their inpatient stay. 21 (0.1%) mortalities were observed;of those, 8 (38.1%) were diagnosed with COVID-19. Mortality was more likely with concurrent COVID-19 infection (OR 31.7, 95% CI 12.4- 81.4, p<0.001), age >80 years, ASA grade ≥3 and ECOG Grade ≥1. 40 (0.2%) respiratory complications (acute respiratory distress syndrome or pneumonia) were observed within 30 days of surgery. Respiratory complications were more likely in patients aged with concurrent COVID-19 infection (OR 40.6, 95%CI 11.4-144.5, p<0.001), age >70 years, from an area with high community risk, or with a revised cardiac risk index ≥1. There were 84 (4.4%) major complications (Clavien-Dindo ≥3). Patients with a concurrent COVID-19 infection (OR 7.5, 95%CI 2.7-20.3, p<0.001), or aged ≥80 years were more likely to experience major complications. Conclusions: Our data can inform health services to safely select patients for surgery during the pandemic. Patients with concurrent COVID-19 infection have a higher risk of mortality and respiratory complications and should not undergo surgery if possible.