Oncourology metamorphoses after the first wave of the COVID-19 pandemic

Introduction. The coronavirus pandemic (COVID-19) had a significant impact on the global healthcare sector and provoked the current oncological care standards revision, including the standards in urological oncology. All changes have affected directly the elective outpatient and inpatient surgical care through the search for a priority and evidence-based treatment option for urological cancer diseases during a tense epidemiological period. Aim. The aim of this study was to assess the short-term results and changes in the urological oncology service on the background of the COVID-19 pandemic first wave. Materials and methods. The outcomes of patients’ treatment in the oncourological surgical department of the FSBI «N.N. Petrov national medical research center of oncology» of the Ministry of Healthcare of the Russian Federation for the period from March 16 to May 18,2020 were analyzed. 96 elective admissions (81.25% - male, 18.75% - female) were performed, of which an elective surgical treatment of a urological cancer was performed in 76 cases (79.2%). The endpoint of this study was the rate of mortality, associated with confirmed SARS-CoV-2 infection after surgery during the 30-day follow-up period. Additionally, risk factors of SARS-CoV-2 infecting during the hospital stay period were analyzed. Statistical analysis (Student's test, Mann-Whitney, Fisher's test, ROC-analysis) was performed using the STATISTICA software (version 10; StatSoft Inc., USA), JASP (version 0.11.1, Netherlands). Results. Over the specified period, COVID-19 infection was detected in 11.5% of cases (n = 11), 12.8% of them were male (n = 10), 5.6% (n = 1) -female patients. Mortality rate during the hospital stay period was 3.1% (n = 3), the rate during the 30-day follow-up period after discharge from the hospital was 2% (n = 2). The average patients’ length of stay before surgery in the group without a confirmed diagnosis of COVID-19 was 1.8 ± 1.7 days, after surgery - 7.3 ± 7.7 days. The average length of stay for patients before surgery in the group with a confirmed diagnosis of COVID-19 was 2.2 ± 1.6 days, after surgery - 12.2 ± 8.9 days. According to the ROC analysis results, the length of the postoperative period was the most significant risk factor for SARS-CoV-2 infecting in the hospital: with a postoperative period of more than 6 days, the risk of COVID-19 infecting was 79.7% (95% CI 0.058-0.743). Other risk factors for COVID-19 infection in the postoperative period (gender, ASA score, body mass index) did not show their significant influence. Conclusion. Carrying out urological cancer procedures on the background of the COVID-19 pandemic can only be carried out with a revision of the strategy for sorting clinical cases according to the severity of the underlying disease, with the strict adherence to clinical guidelines and the evidence-based medicine principles. An additional option to reduce the burden on the healthcare system and reduce the likelihood of SARS-CoV-2 infection could be the fast track principles aimed at accelerated postoperative patient recovery.