Deferring Elective Urologic Surgery During the COVID-19 Pandemic: The Patients' Perspective

Abstract

Objectives: To explore the perspective of urological patients on the possibility to defer elective surgery due to the fear of contracting COVID-19.

Methods: All patients scheduled for elective urological procedures for malignant or benign diseases at 2 high-volume centers were administered a questionnaire, through structured telephone interviews, between April 24 and 27, 2020. The questionnaire included 3 questions: (1) In light of the COVID-19 pandemic, would you defer the planned surgical intervention? (2) If yes, when would you be willing to undergo surgery? (3) What do you consider potentially more harmful for your health: the risk of contracting COVID-19 during hospitalization or the potential consequences of delaying surgical treatment?

Results: Overall, 332 patients were included (51.5% and 48.5% in the oncology and benign groups, respectively). Of these, 47.9% patients would have deferred the planned intervention (33.3% vs 63.4%; P < .001), while the proportion of patients who would have preferred to delay surgery for more than 6 months was comparable between the groups (87% vs 80%). These answers were influenced by patient age and American Society of Anesthesiologists score (in the Oncology group) and by the underlying urological condition (in the benign group). Finally, 182 (54.8%) patients considered the risk of COVID-19 potentially more harmful than the risk of delaying surgery (37% vs 73%; P < .001). This answer was driven by patient age and the underlying disease in both groups.

Conclusions: Our findings reinforce the importance of shared decision-making before urological surgery, leveraging patients' values and expectations to refine the paradigm of evidence-based medicine during the COVID-19 pandemic and beyond.

Figure 1

Patients’ perspectives on refusal of elective urological surgery and their drivers, stratified by the nature of underlying urological condition (malignant disease [group A] vs benign disease [group B]). The factors influencing the answers to questions Q1-Q3 are shown in the lower portion of the figure and are highlighted in light grey (for patient-related variables) and dark grey (for disease-related variables). ASA, American Society of Anesthesiologists. (Color version available online.)