The THYCOVIT (Thyroid Surgery during COVID-19 pandemic in Italy) study: results from a nationwide, multicentric, case-controlled study

Abstract

The outbreak of the COVID-19 pandemic has led to a disruption of surgical care. The aim of this multi-centric, retrospective study was to evaluate the impact of the pandemic on surgical activity for thyroid disease among the Italian Units of Endocrine Surgery. Three phases of the pandemic were identified based on the epidemiological situation and the public measures adopted from the Italian Government (1st phase: from 9th March to 3rd May 2020; 2nd phase: from 4th May to 14th June; 3rd phase: from 15th June to 31st). The patients operated upon during these phases were compared to those who underwent surgery during the same period of the previous year. Overall, 3892 patients from 28 Italian endocrine surgical units were included in the study, 1478 (38%) operated upon during COVID-19 pandemic, and 2414 (62%) during the corresponding period of 2019. The decrease in the number of operations was by 64.8%, 44.7% and 5.1% during the three phases of COVID-19 pandemic, compared to 2019, respectively. During the first and the second phases, the surgical activity was dedicated mainly to oncological patients. No differences in post-operative complications were noted between the two periods. Oncological activity for thyroid cancer was adequately maintained during the COVID-19 pandemic.

Thyroid surgery during the COVID-19 pandemic: results from a systematic review

“…Personal protection equipment consisting of N95 masks, eye protection, gloves, and gowns was adopted by medical staff in all the studies. The average hospital length of stay was three days in four studies [25][26][27]30] and two days in one study [28]. The mean operating time was reported by two studies [27,30], and it varied from 57 to 90 min.…”

“…1 Flowchart of study selection process to an operated case of PTC [20], one regarding potential surgical candidates who underwent active surveillance [21]. Nine English language studies had appropriate data for systematic review [22][23][24][25][26][27][28][29][30].…”

“…These studies were performed across several countries: three in China [23,27,28], three in Italy [25,29,30], one in USA [26], one in Jordan [22], while the remaining one enrolled a cohort of patients from 26 countries [24]. They were seven single-center observational cohort studies [22,23,[25][26][27][28][29] and two were multi-center studies [24,30], all with a retrospective study design except for two prospective studies [24,28]. Overall, the studies took place between January and August 2020 in countries with community SARS-CoV-2 prevalence varying from low to high.…”

“…Overall, the studies took place between January and August 2020 in countries with community SARS-CoV-2 prevalence varying from low to high. The total number of patients undergoing thyroid surgery was 2217, they were aged from 11 to 80 years, 1531 were females and 571 males (female/male ratio ~ 3, with gender reported in five studies [22,24,27,28,30]). The indication for surgery was malignancy in 1347 (60.8%) and benign thyroid disease in 870 (39.2%) cases.…”

“…The size of the primary lesion could vary from occult [22] to more than 40 mm [22,24,27]. Screening protocols for SARS-CoV-2 detection in hospitalized patients could be based only on COVID-19-related symptoms [22,26] or on also swab and blood tests [25,30] and chest computed tomography (CT) [23,24,[27][28][29]. Personal protection equipment consisting of N95 masks, eye protection, gloves, and gowns was adopted by medical staff in all the studies.…”