Impact of COVID-19 outbreak on urology surgical waiting lists and waiting lists prioritization strategies in the post-COVID-19 era

Abstract

Introduction The suspension of most elective surgeries during COVID-19 pandemic caused the lengthening of urology surgical waiting lists. The objective of this study is to evaluate the impact of COVID-19 pandemic on urology surgical waiting list in a high-volume hospital. Methods An observational descriptive study was designed. All patients included in the urology surgical waiting list of our high-volume center on May 1 st 2020 (46 days after the suspension of elective surgery) were analyzed. Baseline variables, priority on the waiting list, main urological disease, type of scheduled surgery, and waiting time were recorded. Other variables recorded were the presence of a urinary catheter, number of accesses to the emergency department, evidence of COVID-19 infection, number of deaths and their cause. The waiting time for each disease was compared with the time to surgery in 2019. Results A total of 350 patients were included. The mean (SD) time on the waiting list was 97.33 (55.47) days. Priority 1 patients, who normally should undergo surgery within 30 days, were on the waiting list for a mean (SD) time of 60.51 (20.14) days. They were mainly patients with ureteral lithiasis (25.6%), high-risk or muscle-invasive bladder cancer (20.9%) and high-risk prostate cancer (13.9%). The mean waiting time had already significantly exceeded the mean time to surgery in 2019 for radical cystectomy (p = 0.04) and URS (p = 0.003). Conclusions The suspension of most elective surgeries due to COVID-19 had a significant impact on urology surgical waiting list of our high-volume center, especially in priority 1 group.

Impact of the COVID-19 Pandemic on Urologic Oncology Surgery: Implications for Moving Forward

“…A significant reduction in waiting time in those months was seen for partial nephrectomy and radical prostatectomy; a reduction trend was seen also for radical nephrectomy/nephroureterectomy and radical cystectomy. A decrease in elective oncological surgical activity has already been reported by other studies, also in the urologic oncology field; however, this finding has been associated to an increase in the average waiting time for surgery [ 3 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Our findings might be explained by the fact that, during the months of the COVID-19 pandemic, fewer cancer diagnoses were performed at our center, leading to a shorter patients’ waiting list for surgery.…”

Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review

“…A total of 53 articles met the inclusion criteria for analysis (Figure 1). Of the 53 articles selected, 37 analyzed changes in realized access applying quantitative methods , through the analysis of medical records (Table 1), 8 analyzed changes in potential access [83][84][85][86][87][88][89][90] via surveys of different population groups, except for one that did the same via analysis of medical records [90] (Table 2), 7 used qualitative methods to analyze the impact on potential access [91][92][93][94][95][96][97] (Table 3), and, finally, 1 study analyzed changes in both realized and potential access [98] using mixed methods (analysis of medical records and semi-structured interviews). Only six of the studies that explored changes in potential access included professionals from the health centers analyzed as a study population, [87,89,92,93,97,98], while the rest focused on patients or the general population.…”

“…In terms of geographical area, 19 studies were conducted in European countries [47,51,53,55,57,62,64,[67][68][69][70]75,79,83,84,88,90,92,95], 9 in North American countries [49,58,59,77,78,80,82,85,86], 9 in Sub-Saharan Africa [46,48,71,72,76,87,93,94,98], 3 in Latin America [60,91,96], 5 in the East Asia-Pacific region [50,56,61,66,81], 3 in South Asia [63,65,74], 2 in the North Africa-Middle East region [52], and, lastly, 3 studies covered various regions…”

COVID-19 and Prostate Cancer: a Complex Scenario With Multiple Facets

“…In the particular case of prostate cancer, the second most frequently diagnosed cancer in men, the COVID-19 pandemic has had a negative impact both on early diagnosis by reducing participation to screening programs [ 10 ] and on time from diagnosis to surgery/radiotherapy [ 11 ], which may translate in a worse prostate-cancer-specific mortality in the next years [ 12 ]. In spite of the hurdles associated with diagnosis of prostate cancer [ 13 ], population-based prostate-specific antigen (PSA) screening has proven to reduce prostate-cancer-specific mortality, although over 1000 men have to be screened to prevent a single death from prostate cancer [ 14 ].…”

“…Another retrospective observational study conducted in 2020 at a high-volume center was designed to assess the impact of COVID-19 on time to surgery of patients on the urology surgical waiting list. In the overall cohort of 350 patients (including 20 patients with prostate cancer), the mean time of 97.33 days on the waiting list was reported, which was significantly longer compared with that reported in 2019 [ 11 ]. In a population-based study exploring patterns of radiotherapy use, mean weekly radiotherapy courses decreased by 19.9% in April, 6.2% in May and 11.6% in June 2020 compared with corresponding months in 2019, with the largest reduction reported for prostate cancer (77.0% in April) [ 15 ].…”