How the First Year of COVID-19 Affected Elective Pediatric Urology Patients: A Longitudinal Study Based on Waiting Lists and Surveys From 10 European Centers

Abstract

Introduction: COVID-19 impacted healthcare systems worldwide, and elective surgical activity was brought to a minimum. Although children were not primarily affected by the disease, pediatric urology was halted by clinical closedown and staff allocation. We aimed to document how these prioritizations affected waiting lists, and to investigate how European centers dealt with the challenge of these logistical and financial prioritizations.

Materials and methods: This was a 1-year prospective study, starting March 2020. Participants were surveyed at 3-month intervals about waiting lists for several common procedures as well as OR capacity and funding. Further, centers retrospectively reported on surgical and outpatient activity rates during 2019-2021. Waiting list tendencies were evaluated in relation to study baseline.

Results: A marked decrease in surgical and outpatient activity was seen in the spring of 2020. Some included pediatric urology centers were able to increase their budget (15%) and staff working hours (20%) during part of the study period. Still, at the end of the study, the centers had increased the total number of patients on waiting lists with 11%, whereas the average days on waiting lists had accumulated with 73%, yielding a total of 6,102 accumulated waiting days in the study population. Centers with decreased resources had markedly negative effects on waiting lists.

Conclusions: Correlations between COVID-19 derived burdening of healthcare systems and the availability of pediatric urology greatly depends on the prioritizations made at individual centers. Ongoing monitoring of these correlations is warranted to safely avoid unnecessary negative impact on the pediatric population.

Keywords: COVID-19; multicenter study; pediatrics; urology; waiting lists.

Figure 1

Waiting list tendencies during the COVID-19 pandemic. Total number of patients and average days on waiting lists across all participating centers for all procedures of interests are presented in absolute numbers. Mean cross-European data on new COVID-19 admissions and completed vaccinations are shown in absolute numbers for intuitive comparison (note these should be read from secondary Y-axis).

Figure 2

Proportional changes in number of patients (straight lines) and mean days (dotted lines) on waiting lists for high-volume pediatric urological procedures during the total study period. The mean proportional changes (in percentage) across all centers are presented with reference to study baseline (March 2020).

Figure 3

Mean monthly number of overall surgeries performed at seven participating centers during the past 3 years presented per annum in absolute numbers.

Figure 4

Mean monthly number of overall consultations performed at seven participating centers during the past 3 years presented per annum in absolute numbers.

Figure 5

Mean number of overall external referrals to pediatric surgical evaluation received at two participating centers during the past 3 years presented per annum in absolute numbers.

Figure 6

Compiled survey data from all centers. Each subfigure represents a question from the survey: (A) Have your financial resources changed after the Covid-19 close-down? (B) Have you now reached the same OR capacity as before close-down? (C) Have you been able to increase team-member working hours (i.e., surgeons, anesthesiologists, OR nurses and postop team), in order to decrease the waiting list? (D) What is the main limiting factor right now for full OR capacity? (E) Did you follow ESPU or national guidelines to deal with the waiting list during and after closedown?

Figure 7

Funding during the study period. Proportional changes in number of patients and mean days waiting for the mean of all high-volume procedures presented in percentage for each center (represented in colors) in relation to funding status at the end of the study (dotted, dashed and straight lines, respectively).

Figure 8

Ability to increase operating room staff working hours. Proportional changes in number of patients and mean days waiting for the mean of all high-volume procedures presented in percentage for each center (represented in colors) in relation to staff working hours at the end of the study (dotted, dashed and straight lines, respectively).