Dataset Information

Estimating the Impact of COVID-19 on Urology: Data from a Large Nationwide Cohort.

ABSTRACT: The impact of the coronavirus disease 2019 (COVID-19) pandemic on urology worldwide has been the subject of frequent speculation, but population-level estimates on changes in urology care are sparsely reported. Here, we use newly released data from a large USA-based cohort to provide further insight into the impact of the pandemic on our field. For a final cohort of 900,900 patient encounters in 418 hospitals, we describe an approximately 20% decrease in urology-specific emergency room (ER) visits (19.4%, 95% confidence interval [CI] 17.4-21.5%), admissions to a urology service (19.3%, 95% CI 13.7-24.9%), and ambulatory urology surgeries (22.9%, 95% CI 13.2-32.6%) during March 2020 relative to baseline. On linear regression, region was the sole predictor of decrease in volume, reflecting the heterogeneous spread of the SARS-CoV-2 virus within the USA. Selected higher-acuity ER presentations, such as obstructing kidney stones and "acute scrotum", appeared to be preserved relative to lower-acuity presentations, such as nonobstructing stones, hematuria, and urinary retention. These data create context for changes observed by individual urology practices and shed light on triage patterns during natural disasters.

Patient summary

The coronavirus disease 2019 (COVID-19) pandemic decreased the amount of urology care provided in the USA by approximately 20% during March 2020. Patients with complaints potentially requiring imaging tests or surgery seemed to come to the emergency room at nearly normal levels.

SUBMITTER: Lewicki P

PROVIDER: S-EPMC7813481 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Estimating the Impact of COVID-19 on Urology: Data from a Large Nationwide Cohort.

Lewicki Patrick P Basourakos Spyridon P SP Al Hussein Al Awamlh Bashir B Wu Xian X Hu Jim C JC Schlegel Peter N PN Shoag Jonathan E JE

European urology open science 20210118

The impact of the coronavirus disease 2019 (COVID-19) pandemic on urology worldwide has been the subject of frequent speculation, but population-level estimates on changes in urology care are sparsely reported. Here, we use newly released data from a large USA-based cohort to provide further insight into the impact of the pandemic on our field. For a final cohort of 900,900 patient encounters in 418 hospitals, we describe an approximately 20% decrease in urology-specific emergency room (ER) visi ...[more]

PMID: 33490992

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Project description:AimThe management of urology patient is currently disrupted by the COVID-19 epidemic. In the field of functional urology, there are clinical situations with a high risk of complication if management is delayed and a great heterogeneity of advisable reprogramming times after cancellation. A prioritization of functional urology procedures is necessary to adapt management during the COVID-19 crisis and to better organize post-epidemic recovery.Material and methodsThe advice of AFU scientific committees in the field of functional urology (neuro-urology, female and perineology, male LUTS) was requested and supplemented by a review of the currently available recommendations on the subject of urology and COVID-19. These opinions were combined to draw up temporary recommendations to help reorganize practices during the epidemic and prepare the post-critical phase.ResultsMost of the recommendations available on career-oriented social networks (Twitter, LinkedIn) or in literature concern cancer or general urology. Eight out of ten propose a cancellation of all functional urology procedures without distinction. But the 3 AFU committees covering the field of functional urology have identified three clinical situations in which surgical procedures that can be maintained during the COVID-19 epidemic (priority level A): conclusion of a neuromodulation test in progress (implantation or explantation), botulinum toxin A bladder injections for unbalanced neurologic bladder, cystectomy and ileal conduit for urinary fistula in perineal bedsore or refractory unbalanced neurologic bladder with acute renal failure and vesico-enteric or prostato-pubic fistulas. Management adaptation of the other pathologies are proposed, as well as the application of 3 priority levels (B, C, D) for rescheduled procedures for a better management of the post-crisis activity resumption.ConclusionThe joint functional urology committees indicate that there are specific clinical situations in this field that demand non-delayed care during COVID crisis. They underline the need to establish a hierarchy for the cancelled surgeries, in order to reduce the arm of long reschedule delays and to optimize post-lockdown activity resumption.

Project description:It remains unknown to what degree resource prioritization toward SARS-CoV-2 (2019-nCoV) coronavirus (COVID-19) cases had disrupted usual acute care for non-COVID-19 patients, especially in the most vulnerable populations such as patients with schizophrenia. The objective was to establish whether the impact of the COVID-19 pandemic on non-COVID-19 hospital mortality and access to hospital care differed between patients with schizophrenia versus without severe mental disorder. We conducted a nationwide population-based cohort study of all non-COVID-19 acute hospitalizations in the pre-COVID-19 (March 1, 2019 through December 31, 2019) and COVID-19 (March 1, 2020 through December 31, 2020) periods in France. We divided the population into patients with schizophrenia and age/sex-matched patients without severe mental disorder (1:10). Using a difference-in-differences approach, we performed multivariate patient-level logistic regression models (adjusted odds ratio, aOR) with adjustment for complementary health insurance, smoking, alcohol and substance addiction, Charlson comorbidity score, origin of the patient, category of care, intensive care unit (ICU) care, major diagnosis groups and hospital characteristics. A total of 198,186 patients with schizophrenia were matched with 1,981,860 controls. The 90-day hospital mortality in patients with schizophrenia increased significantly more versus controls (aOR = 1.18; p < 0.001). This increased mortality was found for poisoning and injury (aOR = 1.26; p = 0.033), respiratory diseases (aOR = 1.19; p = 0.008) and for both surgery (aOR = 1.26; p = 0.008) and medical care settings (aOR = 1.16; p = 0.001). Significant changes in the case mix were noted with reduced admission in the ICU and for several somatic diseases including cancer, circulatory and digestive diseases and stroke for patients with schizophrenia compared to controls. These results suggest a greater deterioration in access to, effectiveness and safety of non-COVID-19 acute care in patients with schizophrenia compared to patients without severe mental disorders. These findings question hospitals' resilience pertaining to patient safety and underline the importance of developing specific strategies for vulnerable patients in anticipation of future public health emergencies.

Dataset Information

Estimating the Impact of COVID-19 on Urology: Data from a Large Nationwide Cohort.

Patient summary

Publications

Estimating the Impact of COVID-19 on Urology: Data from a Large Nationwide Cohort.

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