Cirugía urológica durante la pandemia por SARS-CoV-2. Análisis descriptivo de la experiencia en un Servicio de Urología durante distintas fases epidemiológicas

Resumen Introduccion: la pandemia por SARS-CoV-2 ha cambiado la practica urologica a nivel mundial Nuestro objetivo es describir los resultados en salud observados en los pacientes intervenidos en el Servicio de Urologia de un hospital terciario, a lo largo de diferentes fases epidemiologicas Metodos: estudio de cohortes observacional que incluye todos los pacientes intervenidos entre el 1 de marzo y el 14 de mayo Segun la organizacion hospitalaria, distinguimos tres periodos: durante las primeras dos semanas no hubo cambios (1er periodo), en las siete semanas siguientes solo se realizaron intervenciones urgentes previa extraccion de exudado nasofaringeo (2o periodo), y tras el 4 de mayo se reanudo la cirugia electiva aplicando un protocolo de cribado multidisciplinar (3er periodo) Las variables demograficas y basales, las quirurgicas y perioperatorias, asi como los resultados postoperatorios, se obtuvieron de forma retrospectiva (periodos 1 y 2) y prospectiva (periodo 3) El seguimiento telefonico se realizo al menos 3 semanas tras el alta hospitalaria Resultados: se realizaron 103 cirugias urologicas y fueron diagnosticados de COVID-19 11 pacientes, 8 de ellos en el 1er periodo El diagnostico era conocido en 1 paciente, mientras que los otros 10 desarrollaron la enfermedad en una media de 25 dias tras la intervencion y 16 6 dias tras el alta Cuatro de siete pacientes trasplantados resultaron afectados Se registraron 3 exitus por la enfermedad: una mujer de 69 anos trasplantada y 2 varones mayores de 80 anos con comorbilidades y alto riesgo anestesico a los que se realizo drenaje de absceso retroperitoneal y cirugia retrograda intrarrenal, respectivamente Conclusiones: la infeccion por SARS-CoV-2 afecto principalmente a trasplantados renales o pacientes anosos con alto riesgo anestesico, durante las 2 primeras semanas de la pandemia Tras implantar la PCR preoperatoria y un protocolo completo de cribado, los casos se redujeron de manera sustancial y se pudo operar con seguridad Introduction: the SARS-CoV-2 pandemic has changed the urological practice around the world Our objective is to describe the outcomes presented by patients undergoing surgery in the urology department of a tertiary hospital, across the pandemic phases Methods: Observational, cohort study including all patients undergoing surgery between the March 1 and May 14 According to the hospital organization, we identified three periods: there were no changes during the first two weeks (1st period), the following seven weeks, when only urgent interventions were carried out after performance of nasopharyngeal swab test (2nd period), and finally, elective surgery was resumed on May 4, after the implementation of a multidisciplinary screening protocol (3rd period) Demographic, baseline, surgical and perioperative variables, as well as postoperative outcomes, were obtained in a retrospective (periods 1 and 2) and prospective (period 3) manner Telephone follow-up was initiated at least 3 weeks after hospital discharge Results: 103 urological surgeries were performed, and 11 patients were diagnosed with COVID-19, 8 of them within the 1st period The diagnosis was clear in 1 patient, while the other 10 developed the disease in an average of 25 days after the intervention and 16 6 days after discharge Of seven transplant patients, four got the infection Three deaths were recorded due to the disease: a 69-year-old woman transplanted and two men over 80 with comorbidities and high anesthetic risk who underwent drainage of retroperitoneal abscess and retrograde intrarenal surgery, respectively Conclusions: SARS-CoV-2 infection mainly affected renal transplant recipients or elderly patients with high anesthetic risk, during the first 2 weeks of the pandemic After implementing preoperative PCR tests and a comprehensive screening protocol, cases were substantially reduced, and safe surgical procedures were achieved