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Vol. 37. Issue 6.
Pages 382-389 (November - December 2022)
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Vol. 37. Issue 6.
Pages 382-389 (November - December 2022)
Original Article
Analysis of patient outcomes after urological surgery during the second and third waves of SARS-CoV-2 pandemic in a high incidence area
Análisis de la evolución de los pacientes intervenidos de cirugía urologica durante la segunda y tercera olas de pandemia de SARS-CoV-2 en un área de alta incidencia
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A. González-Díaza,
Corresponding author
alejandroglezdiaz@gmail.com

Corresponding author.
, J. Gil-Moradilloa, N. Rosillo-Ramírezb, C. Varela-Rodríguezc, A. Rodríguez-Antolína, Á. Tejido-Sáncheza
a Urology Service, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain
b Preventive Medicine Service, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain
c Quality Healthcare Unit, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain
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Abstract
Objective

To analyze surgical safety through postoperative COVID-19 incidence and mortality at the urology department of a tertiary hospital located in Madrid (Spain).

Methods

Observational, prospective study including all patients undergoing urological surgery from 1st March 2020 to 28th February 2021. According to the hospital organization and local epidemiological situation we delimitate three epidemic waves. A set of screening and protective measures was applied from 4th May onwards. Demographic, baseline, surgical and perioperative variables, as well as postoperative outcomes, were collected. Telephone follow-up was performed at least 3 weeks after hospital discharge.

Results

940 urological surgeries were performed, 12 of them had to be rescheduled due to active or recent SARS-CoV-2 infection identified by the screening protocol. Thirty-one patients developed COVID-19 (3.3% incidence) and 7 died (22.6% mortality). The average time to onset of symptoms was 62.6 days after discharge, being 25 cases attributable to community transmission. The remaining 6 cases, due to in-hospital transmission, had worse outcomes. Five of them were identified during the first wave, especially when no preoperative PCR was obtained. In contrast, during the second and third waves, fewer and milder cases were diagnosed, with just 1 in-hospital transmission among 857 urological patients.

Conclusions

After implementing complete protective measures, postoperative in-hospital COVID-19 cases almost disappeared, even during the second and third waves. Most of the cases were due to community transmission and thus driven by the general epidemiological situation. While hospitals follow recommendations to avoid COVID-19 infection, urological surgery remains safe and can be maintained.

Keywords:
COVID-19
SARS-CoV-2
Pandemic
Surgery
Postoperative infection
Screening protocol
Resumen
Objetivo

Analizar la seguridad de la cirugía, en términos de incidencia y mortalidad de los casos de COVID-19 postoperatorio, en el Servicio de Urología de un hospital terciario de Madrid (España).

Métodos

Estudio prospectivo que incluye todos los pacientes sometidos a cirugía urológica, desde el 1 de marzo de 2020 al 28 de febrero de 2021. Según la organización hospitalaria y la situación epidemiológica local, distinguimos tres ondas epidémicas. Un conjunto de medidas de cribado y protección se aplicó desde el 4 de mayo en adelante. Se recogieron variables demográficas, basales, quirúrgicas, peri y postoperatorias. Se realizó seguimiento telefónico al menos 3 semanas tras el alta hospitalaria.

Resultados

Se realizaron 940 cirugías urológicas, teniendo que posponer 12 de ellas debido a infección activa o reciente por SARS-CoV-2 (identificadas por el protocolo de cribado). Treinta y un pacientes desarrollaron COVID-19 (incidencia del 3.3%) y 7 murieron (mortalidad del 22.6%). La media hasta el desarrollo de los síntomas fue de 62.6 días tras el alta, siendo 25 de los casos atribuibles a contagio en la comunidad. Los 6 casos restantes, por transmisión intrahospitalaria, fueron más severos. Cinco de ellos ocurrieron en la primera ola, sobre todo cuando aún no se realizaba PCR preoperatoria. Por el contrario, durante la segunda y tercera olas se diagnosticaron menos casos y fueron más leves, con solo una transmisión intrahospitalaria entre 857 pacientes.

Conclusiones

Tras implementar un protocolo de medidas preventivas, los casos de COVID-19 postoperatorio casi desaparecieron, incluso durante los repuntes de segunda y tercera ola. La mayoría de casos se debieron a transmisión comunitaria, influidos por la situación epidemiológica local. Mientras los hospitales sigan las recomendaciones para evitar la COVID-19, la cirugía urológica es segura y puede continuar.

Palabras clave:
COVID-19
SARS-CoV-2
Pandemia
Cirugía
Infección postoperatoria
Protocolo de cribado

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