Perioperative outcomes of patients undergoing urological elective surgery during the COVID-19 pandemic: a national overview across 28 Italian institutions

Minervini, Andrea; Di Maida, Fabrizio; Mari, Andrea; Porreca, Angelo; Rocco, Bernardo; Celia, Antonio; Bove, Pierluigi; Umari, Paolo; Volpe, Alessandro; Galfano, Antonio; Pastore, Antonio Luigi; Annino, Filippo; Parma, Paolo; Greco, Francesco; Nucciotti, Roberto; Schiavina, Riccardo; Esposito, Fabio; Romagnoli, Daniele; Leonardo, Costantino; Falabella, Roberto; Gallo, Fabrizio; Amenta, Michele; Sciorio, Carmine; Verze, Paolo; Tafuri, Alessandro; Pucci, Luigi; Varca, Virginia; Zaramella, Stefano; Pagliarulo, Vincenzo; Bozzini, Giorgio; Ceruti, Carlo; Falsaperla, Mario; Cafarelli, Angelo; Antonelli, Alessandro

INTRODUCTION: The aim of this study was to assess the safety of elective urological surgery performed during the pandemic by estimating the prevalence of COVID-19-like symptoms in the postoperative period and its correlation with perioperative and clinical factors. MATERIAL AND METHODS: In this multicenter, observational study we recorded clinical, surgical and postoperative data of consecutive patients undergoing elective urological surgery in 28 different institutions across Italy during initial stage of the COVID-19 pandemic (between February 24 and March 30, 2020, inclusive). RESULTS: A total of 1943 patients were enrolled. In 12%, 7.1%, 21.3%, 56.7% and 2.6% of cases an open, laparoscopic, robotic, endoscopic or percutaneous surgical approach was performed, respectively. Overall, 166 (8.5%) postoperative complications were registered, 77 (3.9%) surgical and 89 (4.6%) medical. Twenty-eight (1.4%) patients were readmitted to hospital after discharge and 13 (0.7%) died. In the 30 days following discharge, fever and respiratory symptoms were recorded in 101 (5.2%) and 60 (3.1%) patients. At multivariable analysis, not performing nasopharyngeal swab at hospital admission (HR 2.3; CI 95% 1.01–5.19; p = 0.04) was independently associated with risk of developing postoperative medical complications. Number of patients in the facility was confirmed as an independent predictor of experiencing postoperative respiratory symptoms (p = 0.047, HR:1.12; CI95% 1.00–1.05), while COVID-19-free type of hospitalization facility was a strong independent protective factor (p = 0.02, HR:0.23, CI95% 0.07–0.79). CONCLUSIONS: Performing elective surgery during the COVID-19 pandemic does not seem to affect perioperative outcomes as long as proper preventive measures are adopted, including nasopharyngeal swab before hospital admission and hospitalization in dedicated COVID-19-free facilities.