Impact of the COVID-19 Pandemic on Urologic Oncology Surgery: Implications for Moving Forward

The COVID-19 pandemic has caused the destruction of routine hospital services globally, leading to an increase in the backlog of elective surgery cases. The aim of the study was to retrospectively investigate the pandemic’s impact on the urologic oncology surgical activity of a high-volume center located in Milan, Italy. The number and type of procedures performed in 2020 during the COVID-19 pandemic was evaluated using 2019 data as control. Waiting times for each surgical procedure were compared, on a bimonthly basis, between the two different years. Overall, a 26.7% reduction in the number of urologic oncology surgeries between 2019 and 2020 was observed (2019: 720, 2020: 528). Both the main indication for surgery and the type of procedure performed significantly differed between 2019 and 2020 (all p < 0.0001), with a decrease in the number of radical prostatectomies and an increase in the number of radical cystectomies and radical nephrectomies/nephroureterectomies performed in 2020. Waiting time decreased by 20% between 2019 and 2020, with the most significant reduction seen after the first wave of the COVID-19 pandemic (July-October 2020), in particular for partial nephrectomy and radical prostatectomy, possibly due to the underdiagnosis of cases. In conclusion, in accordance with recommendations by international urological societies on prioritization strategies for oncological procedures, a higher proportion of surgeries for high-risk tumors was performed in 2020 at our center at the expense of procedures for lower risk diseases; however, future implications for patients’ prognosis still need to be determined.

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UTILIZATION OF HEMODYNAMIC SUPPORT DEVICES IN HIGH-RISK PCI: EXPERIENCE FROM A HIGH VOLUME CENTER

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)31956-2 ◽

2020 ◽

Vol 75 (11) ◽

pp. 1329

Author(s):

Arber Kodra ◽

Adam Prince ◽

Neil Coplan

Keyword(s):

High Risk ◽

High Volume ◽

Hemodynamic Support ◽

High Volume Center ◽

Support Devices

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P-P37 Robot assisted pancreaticojejunostomy may be associated with lower risk of post-operative pancreatic fistula in high-risk cases: Initial experience

British Journal of Surgery ◽

10.1093/bjs/znab430.259 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Alexia Farrugia ◽

Qazi Rahim Muhammad ◽

Omar Jalil ◽

Majid Ali ◽

Gabriele Marangoni ◽

...

Keyword(s):

High Risk ◽

Pancreatic Fistula ◽

Lower Risk ◽

High Volume ◽

High Risk Group ◽

Initial Experience ◽

Robot Assisted ◽

Robotic Assisted ◽

Encrypted Database ◽

Robotic Pancreaticoduodenectomy

Abstract Background Robot assisted pancreaticoduodenectomy has increased in popularity over recent years. There is evidence from high volume centers which suggests that it is associated with lower risk of post-operative pancreatic fistula than open surgery. The aims of this study were to evaluate our initial experience after robotic assisted pancreaticoduodenectomy and compare if a low volume center can produce similar positive outcomes. Methods The initial 12 patients who were listed for a robot assisted pancreaticoduodenectomy were included in the study in a consecutive manner. A standardised method of anastomosis was used in all surgeries, this being a duct-to-mucosa two-layer modified Blumgart pancreato-jejunostomy. Data was collected prospectively and stored in an encrypted database. Surgical outcomes were then analysed. Results The study included first 12 consecutive patients who underwent robotic pancreaticoduodenectomy between August 2019 and January 2020. None of the patients had clinically relevant postoperative pancreatic fistula despite 75% of the patients falling into moderate to high-risk group for fistula development. Median operative time and length of stay was 547 minutes and 8 days respectively with three Clavien Dindo grade III complications and three Clavien-Dindo grade II complications. Conclusions Robotic assisted pancreaticoduodenectomy maybe associated with lower risk of post-operative pancreatic fistula in high-risk cases.

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The role of reference pathology to assess MRI-TRUS fusion prostate biopsies in a tertiary referral center.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.32 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 32-32

Author(s):

Tobias Kohl ◽

Melanie von Brandenstein ◽

Timur H. Kuru ◽

Nienke Hansen ◽

Thorsten Persigehl ◽

...

Keyword(s):

High Risk ◽

Risk Stratification ◽

High Volume ◽

Risk Groups ◽

Tertiary Referral Center ◽

Prostate Biopsies ◽

Biopsy Specimens ◽

Planning Methods ◽

High Volume Center ◽

Reference Pathology

32 Background: Risk stratification for patients diagnosed with prostate cancer (PCa) through MR-TRUS fusion biopsy still relies on Gleason (GL) grading of the biopsy specimens. GL grading of the same sample can differ between pathologists. In our tertiary high-volume center GL grading of the biopsy specimens is crucial for further therapy planning. Methods: Reference pathology of 42 patients after transperineal MR-TURS fusion plus saturation biopsy was assessed by one specialized genitourinary pathologist. GL grading of the original pathology and the reference pathology for the saturation and targeted biopsy cores were compared. Risk groups for this study were set as GL 6 for low, GL 7a and GL 7b for intermediate and GL 8, GL 9 and GL 10 for high-risk. Results: In 42 patients 49 lesions were identified by mpMRI (PI-RADS 3-5) in which 150 biopsy cores were taken. In addition, 709 cores were taken as saturation biopsies. The highest GL grading per patient differed in 18 (43 %) of the cases. In 16 cases, there was a difference within the targeted biopsies but only in 8 cases there was a difference in the saturation biopsies. In 6 cases both saturation and fusion biopsies were different. Taking risk stratification into account there was a misclassification with low- and intermediate risk in 9 (21 %) cases, an intermediate- and high risk in 2 cases and a misclassification within the same risk group in 6 (14 %) cases. In 16 of the 18 differences there was an upgrading of the Gleason score by the reference pathologist whereas only in 2 cases there was a downgrading. Conclusions: The data shows that in times of mpMRIs and transperineal MRI-TRUS fusion biopsies it still is the GL score graded by the pathologist who accounts for many potential therapy plan mistakes. In this study 21 % of the patients were misclassified as GL 6 while reference pathology graded for GL 7a or GL 7b. The demonstrated data suggests that there should be a reference pathology at least for every GL 6 cancer and that the quality of GL grading should be monitored. Also this data again addresses the need for a better risk stratification irrespective of the GL score that can be done in a more objective way with less potential for misclassification.

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Predictors of preprocedural direct oral anticoagulant levels in patients having an elective surgery or procedure

Blood Advances ◽

10.1182/bloodadvances.2020002335 ◽

2020 ◽

Vol 4 (15) ◽

pp. 3520-3527

Author(s):

Joseph R. Shaw ◽

Na Li ◽

Thomas Vanassche ◽

Michiel Coppens ◽

Alex C. Spyropoulos ◽

...

Keyword(s):

High Risk ◽

Lower Risk ◽

Elective Surgery ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Low Risk ◽

Clinical Parameters ◽

Regression Analyses ◽

Female Sex ◽

Perioperative Anticoagulation

Abstract The Perioperative Anticoagulation Use for Surgery Evaluation (PAUSE) study prospectively evaluated a prespecified periprocedural-interruption strategy of direct oral anticoagulants (DOACs) among patients with atrial fibrillation. Logistic regression analyses were performed to identify clinical parameters associated with residual DOAC levels ≥30 ng/mL or ≥50 ng/mL. Patients undergoing low-bleed-risk procedures were more likely to have residual levels of ≥30 ng/mL and ≥50 ng/mL. For low-risk procedures, age ≥75 years, female sex, a creatinine clearance (CrCl) <50 mL/min, and an interruption of <36 hours were associated with a greater likelihood of levels ≥30 ng/mL, whereas age ≥75 years, female sex, a CrCl of <50 mL/min, and standard DOAC dosing were associated with levels ≥50 ng/mL. For high-risk procedures, weight of <70 kg, CrCl <50 mL/min, and standard DOAC dosing were associated with residual levels ≥30 ng/mL, whereas female sex was associated with levels ≥50 ng/mL. For low-risk procedures, apixaban was associated with a higher likelihood of levels ≥30 ng/mL as compared with dabigatran (P = .0019) and of levels ≥50 ng/mL when compared with rivaroxaban (P = .0003). For high-risk procedures, apixaban was marginally associated with a higher likelihood of residual levels ≥30 ng/mL when compared with dabigatran (P = .05), whereas rivaroxaban was associated with a higher likelihood of levels ≥30 ng/mL as compared with apixaban. Further study is required to determine whether adjustments to perioperative plans based on these clinical parameters could result in a lower risk of residual DOAC levels. The PAUSE trial was registered at www.clinicaltrials.gov as #NCT2228798.

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Robotic Radical Prostatectomy in Patients with High-Risk Disease: A Review of Short-Term Outcomes from a High-Volume Center

Journal of Endourology ◽

10.1089/end.2010.0349 ◽

2011 ◽

Vol 25 (3) ◽

pp. 455-457 ◽

Cited By ~ 38

Author(s):

Gautam Jayram ◽

Guarionex J. Decastro ◽

Michael C. Large ◽

Aria Razmaria ◽

Gregory P. Zagaja ◽

...

Keyword(s):

High Risk ◽

Radical Prostatectomy ◽

High Volume ◽

Short Term ◽

Robotic Radical Prostatectomy ◽

High Risk Disease ◽

High Volume Center

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Eight-years trends and outcomes in TAVI performed in a high-volume center

European Heart Journal ◽

10.1093/ehjci/ehaa946.2596 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Tagliari ◽

P.K Haager ◽

M Miura ◽

G Russo ◽

A Pozzoli ◽

...

Keyword(s):

High Risk ◽

Severe Aortic Stenosis ◽

High Volume ◽

Chronic Obstructive ◽

Funding Source ◽

Femoral Access ◽

High Risk Patients ◽

Risk Patients ◽

High Volume Center ◽

Sts Score

Abstract Introduction Since the first transcatheter aortic valve implantation (TAVI), remarkable changes in procedure features and patients' profile have been reported, making it a widespread treatment for severe aortic stenosis in all risk-class patients. Purpose To evaluate TAVI contemporary trends and outcomes in the last 8 years in a high-volume TAVI center. Methods Data of adult patients submitted to TAVI from April 2012 to April 2019 in a high-volume center were obtained from the Swiss TAVI registry, a prospective national multi-center database. Patients were divided according to implant period in two groups: 1) TAVI performed from 2012 to 2016, and 2) TAVI performed from 2017 to 2019. Results Over a 8-years period, a total of 1485 procedures were performed, increasing from 95 in 2012 to 320 in 2018 (p<0.001). A remarkable modification in patients' profile and procedure characteristics can be seen in Table 1. Despite higher age and surgical risk, a significant decrease in 1-year mortality (6.8% vs. 3.2%; p<0.001) was observed in the last 3 years. This difference was especially notable in the subgroup of high-risk patients (STS score ≥8), who presented a decrease in 30-days (5% vs. 3.3%; p=0.001) and 1-year mortality (13.1% vs. 4.9%; p<0.001). In multivariate analysis, age (OR 1.05, 95% CI: 1.0–1.1), non-femoral access (OR 2.7, 95% CI: 1.2–6.0), and STS score (OR 1.07, 95% CI: 1.0–1.1) were independent predictors of in-hospital mortality, while male gender (OR 1.8, 95% CI: 1.0–3.2), chronic obstructive pulmonary disease (OR 2.1, 95% CI: 1.1–3.9), and STS score (OR 1.07, 95% CI: 1.01–1.14) were predictors of 1-year mortality. Conclusion Significant changes in patients' profile and procedure characteristics were observed in the last 3 years of TAVI experience. Even performed in elderly and high-risk patients, TAVI was associated with low early and 1-year mortality. The Swiss TAVI registry offers a unique opportunity to monitor trends and outcomes in patient submitted to TAVI. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): APT is a Ph.D. study and her scientific research is supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (Capes) - Finance Code 001.

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COST-UTILITY OF WAITING TIME IN TOTAL JOINT REPLACEMENTS: A RANDOMIZED CLINICAL TRIAL

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462312000657 ◽

2013 ◽

Vol 29 (1) ◽

pp. 27-34 ◽

Cited By ~ 2

Author(s):

Ulla Tuominen ◽

Harri Sintonen ◽

Pasi Aronen ◽

Johanna Hirvonen ◽

Seppo Seitsalo ◽

...

Keyword(s):

Waiting Time ◽

Elective Surgery ◽

Waiting Times ◽

High Volume ◽

Developed Countries ◽

The United States ◽

Cost Utility ◽

Joint Replacements ◽

Total Joint Replacements ◽

Mean Waiting Time

In many Western countries, long waiting times for elective surgery are a concern. Major joint replacement is an example of a type of surgery with a high volume of demand and relatively long waiting periods for patients. As populations get older, the prevalence of slowly progressive diseases, such as osteoarthritis (OA) in hip and knee joints, is increasing. Over three-quarters of a million total hip and knee replacement surgeries are done in the United States annually (1). Furthermore, according to March et al. (1997), the costs of OA have been estimated to account for up to 1–2.5 percent of the Gross National Product (GNP) in several developed countries (2). In Finland, a total of 11,104 total joint replacements (TJRs) were performed in 2004 (hip 6,600 and knee 5,905), with the median waiting time of 181 days for the surgery (hip 153 and knee 209 days). Until 2007, the number of TJRs was 17,334 (hip 7,698 and knee 9,636), with a median waiting time of 120 and 142 days, respectively (3;4). The mean waiting time for elective surgical procedures is approximately 3 months in several countries and the maximum waiting times can stretch into years.

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