Safety of hot and cold site admissions within a high volume urology department in the United Kingdom at the peak of the COVID-19 pandemic

Importance: Contracting COVID-19 peri-operatively has been associated with a mortality rate as high as 23%. Using hot and cold sites has led to a low rate of post-operative diagnosis of COVID-19 infection and allowed safe continuation of important emergency and cancer operations in our centre. Objective: The primary objective was to determine the safety of the continuation of surgical admissions and procedures during the height of the COVID-19 pandemic using hot and cold surgical sites. The secondary objective is to determine risk factors of contracting COVID-19 to help guide further prevention. Setting: A single surgical department at a tertiary care referral centre in London, United Kingdom. Participants: All consecutive patients admitted under the care of the urology team over a 3-month period from 1st March to 31st May 2020 over both hot acute admission sites and cold elective sites were included. Exposures: COVID-19 was prevalent in the community over the three months of the study at the height of the pandemic. The majority of elective surgery was carried out in a cold site requiring patients to have a negative COVID-19 swab 72 hours prior to admission and to self-isolate for 14 days pre-operatively, whilst all acute admissions were admitted to the hot site. Main outcomes and measures: COVID-19 was detected in 1.6% of post-operative patients. There was 1 (0.2%) post-operative mortality due to COVID-19. Results: A total of 611 patients, 451 (73.8%) male and 160 (26.2%) female, with a median age of 57 (interquartile range 44-70) were admitted under the surgical team. Of these, 101 (16.5%) were admitted on the cold site and 510 (83.5%) on the hot site. Surgical procedures were performed in 495 patients of which 8 (1.6%) contracted COVID-19 post-operatively with 1 (0.2%) post-operative mortality due to COVID-19. Overall, COVID-19 was detected in 20 (3.3%) patients with 2 (0.3%) deaths. On multivariate analysis, length of stay was associated with contracting COVID-19 in our cohort (OR 1.25, 95% CI 1.13-1.39). Conclusions and Relevance: Continuation of surgical procedures using hot and cold sites throughout the COVID-19 pandemic was safe practice, although the risk of COVID-19 remained and is underlined by a post-operative mortality. Reducing length of stay may be able to reduce contraction of COVID-19.