The dramatic COVID 19 outbreak in Italy is responsible of a huge drop of urological surgical activity: a multicenter observational study

Abstract

Objective: To describe the trend in surgical volume in urology in Italy during the coronavirus disease 2019 (COVID-19) outbreak, as a result of the abrupt reorganisation of the Italian national health system to augment care provision to symptomatic patients with COVID-19.

Methods: A total of 33 urological units with physicians affiliated to the AGILE consortium (Italian Group for Advanced Laparo-Endoscopic Surgery; www.agilegroup.it) were surveyed. Urologists were asked to report the amount of surgical elective procedures week-by-week, from the beginning of the emergency to the following month.

Results: The 33 hospitals involved in the study account overall for 22 945 beds and are distributed in 13/20 Italian regions. Before the outbreak, the involved urology units performed overall 1213 procedures/week, half of which were oncological. A month later, the number of surgeries had declined by 78%. Lombardy, the first region with positive COVID-19 cases, experienced a 94% reduction. The decrease in oncological and non-oncological surgical activity was 35.9% and 89%, respectively. The trend of the decline showed a delay of roughly 2 weeks for the other regions.

Conclusion: Italy, a country with a high fatality rate from COVID-19, experienced a sudden decline in surgical activity. This decline was inversely related to the increase in COVID-19 care, with potential harm particularly in the oncological field. The Italian experience may be helpful for future surgical pre-planning in other countries not so drastically affected by the disease to date.

Keywords: #COVID19; #Urology; #uroonc; COVID-19 outbreak; trend of variation; urological surgery.

Fig. 1

Map of geographical stratification: Centres from Lombardy (seven Centers) (dark grey). Centres from northern regions bordering with Lombardy with COVID‐19 presence as by (Piedmont, Emilia‐Romagna, Veneto; 10 Centres) (grey). Centres from other Italian regions (16 Centers) (white).

Fig. 2

Overall Italian trend of elective surgery among urological involved centres (percentage variation from the pre‐infection baseline status). Trend of COVID‐19‐related care in Italy, defined as hospitalisation and ICU‐bed occupation (whisker extending from minimum to maximum). Red line: trend of variation of surgical procedures. Blue line: (continuous) number of new diagnosis. blue line: (dotted) number of hospitalised patients. Feb, February; Mar, March; k, thousand of cases.

Fig. 3

Trend of elective surgery among urological involved centres stratified by area (A: Lombardy; B: regions neighbouring Lombardy; C: other regions). Box plots indicate the variability of surgical volumes between centres at different time frames (whisker extending from minimum to maximum). Feb, February; Mar, March; k, thousand of cases.

Fig. 4

Curves and time‐line trend of COVID‐19 outbreak in Italy and in the USA (source of data: worldometers.info). The USA trend reflects the Italian one with a delay of roughly 9 days.