Introduction: COVID-19 has caused significant disruption to the management of urological cancer, this study aims to assess 30-day postoperative outcomes for patients undergoing urological cancer surgery during the COVID-19 pandemic.
Methods: COVIDSurg study is the largest international, multicentre study of COVID-19 in surgical patients performed to date. COVIDSurg-Cancer explored the safety of performing elective cancer surgery during the pandemic. All bladder, kidney, UTUC and prostate cancer patients who underwent elective cancer surgery between March 2020 and July 2020 were included. Univariable and multivariable regression was performed to assess association of patient factors with mortality, respiratory complications and operative complications.
Results: A total of 1,902 patients from 36 countries were included. 658 (34.6%) patients had bladder cancer, 590 (31.0%) kidney cancer or UTUC, and 654 (34.4%) prostate cancer. These patients underwent elective curative surgery for their cancers (prostatectomies, nephrectomies, cystectomies, nephroureterectomy, TURBTs). 62% of sites were not designated “hot” COVID-19 sites (i.e. did not actively admit patients with COVID-19).A total of 42/1902 (0.2%) patients were diagnosed with COVID-19 during their inpatient stay.
21 (0.1%) mortalities were observed; of those, 8 (38.1%) were diagnosed with COVID-19. Mortalities were found to be more likely in patients with concurrent COVID-19 infection (OR 31.7, 95% CI 12.4- 81.42, p<0.001), aged over 80, ASA grade 3+ and ECOG grade 1+.
40 (0.2%) respiratory complications (acute respiratory distress syndrome or pneumonia) were observed within 30 days of surgery. Respiratory complications were more likely in patients aged with concurrent COVID-19 infection (OR 40.6, 95%CI 11.41-144.45, p<0.001), over 70, from an area with high community risk or with a revised cardiac risk index of 1+.
There were 84 major complications (Clavien-Dindo score =3). Patients with a concurrent COVID-19 infection (OR 7.45, 95% CI 2.73-20.3, p<0.001) or aged 80 or above were more likely to experience major complications.
Conclusions: Elective urological cancer surgeries are safe to perform during the COVID-19 pandemic. This study highlights important risk-factors associated with worse outcomes. Our data can inform health services to safely select patients for surgery during the pandemic. Patients with concurrent COVID-19 infection have a higher risk of mortality and respiratory complications and should not undergo surgery if possible.
Source of Funding: Funded by The Urology Foundation and BJUI International.