Deferring Elective Urologic Surgery During the COVID-19 Pandemic: the Patients’ Perspective

Campi, Riccardo; Tellini, Riccardo; Grosso, Antonio Andrea; Amparore, Daniele; Mari, Andrea; Viola, Lorenzo; Cocci, Andrea; Polverino, Paolo; Checcucci, Enrico; Alessio, Paolo; Fiori, Cristian; Minervini, Andrea; Carini, Marco; Porpiglia, Francesco; Serni, Sergio

OBJECTIVES: To explore the perspective of urological patients on the possibility to defer elective surgery due to the fear of contracting COVID-19. METHODS: All patients scheduled for elective urological procedures for malignant or benign diseases at two high-volume Centres were administered a questionnaire, through structured telephone interviews, between 24(th) and 27(th) April 2020. The questionnaire included three questions: 1) In light of the COVID-19 pandemic, would you defer the planned surgical intervention? 2) If yes, when would you be willing to undergo surgery? 3) What do you consider potentially more harmful for your health: the risk of contracting COVID-19 during hospitalization or the potential consequences of delaying surgical treatment? RESULTS: Overall, 332 patients were included (51.5% and 48.5% in the oncology and benign groups, respectively). Of these, 47.9% patients would have deferred the planned intervention (33.3% vs 63.4%; p<0.001), while the proportion of patients who would have preferred to delay surgery for more than six months was comparable between the groups (87% vs 80%). These answers were influenced by patient age and ASA score (in the Oncology group) and by the underlying urological condition (in the benign group). Finally, 182 (54.8%) patients considered the risk of COVID-19 potentially more harmful than the risk of delaying surgery (37% vs 73%; p<0.001). This answer was driven by patient age and the underlying disease in both groups. CONCLUSIONS: Our findings reinforce the importance of shared decision-making before urological surgery, leveraging patients’ values and expectations to refine the paradigm of evidence-based medicine during the COVID-19 pandemic and beyond.