Dr. Ingels notes that it is important to acknowledge risk assessment of the pandemic in surgery. Data from the COVIDSurg Collaborative reported 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection among 235 hospitals, 24 countries, and 1,128 patients undergoing surgery from January 1-March 31, 2020, including 294 (26.1%) COVID-positive patients. The 30-day mortality rate was 23.8% and the pulmonary complication rate was 51.2%. Predicting factors for 30-day mortality included age >70 years, male, ASA 3-5, emergency surgery, oncology surgery, and major surgery as summarized below:1
Dr. Ingels was lead author on a Parisian experience assessing urologic surgical activity published last year in BJU International. This study captured every patient receiving a urological procedure in Paris academic urological centers during the four initial weeks of surgical restrictions. During this period, 552 patients received surgery within 8 centers. Among the 11 preoperative COVID‐19 cases, one remained in ICU, no new admission, and no death. For the non‐COVID patients, 57 (12%) developed COVID‐related symptoms; only one case (0.2%) required COVID‐19 specific ICU and 3 (0.6%) patients died of COVID‐19 after surgery. Among these operations, there were 235 oncological surgeries, including one who was preoperatively COVID-19 positive, and seven post-op COVID positive patients. Furthermore, there were 87 oncology robotic procedures, including 35 radical prostatectomies, 20 radical nephrectomies, 20 partial nephrectomies, seven radical cystectomies, and five lymphadenectomies. Among these patients there were three post-operative COVID diagnoses, with no ICU admissions and no mortalities. 2
In a study assessing elective cancer surgery in COVID-19 free surgical pathways, Glasbey et al.3 reported that 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% versus 4.9%; adjusted OR 0.62, 95% CI 0.44 to 0.86). Additionally, the postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% versus 3.6%; adjusted OR 0.53, 95% CI 0.36 to 0.76). Specific to urology patients in this surgery, 15 of 436 (3.4%) patients had a pulmonary complication (adjusted OR 0.64, 95% CI 0.36 to 1.12).
Dr. Ingels concluded with the following take-home messages:
- It remains difficult to draw definitive conclusions from the current robotic data
- In the first wave of studies, there was no systematic pre- and post-operative tests and most asymptomatic cases were missed
- The landscape is continuously changing, particularly with regards to the impact of vaccination and new COVID-19 variants
Presented by: Alexandre Ingels, MD, University Hospital Henri Mondor, Paris, France
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, Twitter: @zklaassen_md, during the 18th Meeting of the EAU Section of Oncological Urology (ESOU21), January 29-31, 2021
References:
1. COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: An international cohort study. Lancet. 2020 Jul 4;396(10243):27-38.
2. Ingels A, Bibas S, Abdessater M, et al. Urology surgical activity and COVID-19: Risk assessment at the epidemic peak: A Parisian multicentre experience. BJU Int2020 Oct;126(4):436-440.
3. Glasbey JC, Nepogodiev D, Simoes JFF, et al. Elective cancer surery in COVID-19-free surgical pathways during the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study. J Clin Oncol. 2021 Jan 1;39(1):66-78.