Department of Urology, Montefiore Medical Center, Bronx, NY, USA.
Albert Einstein College of Medicine, Bronx, NY, USA.
BMC Surg. 2021 Mar 6;21(1):116. doi: 10.1186/s12893-021-01067-9.
The first wave of the COVID-19 pandemic in March 2020 forced our healthcare system in the Bronx, New York to cancel nearly all scheduled surgeries. We developed a framework for prioritizing postponed urologic surgeries that was utilized once cases were permitted to be rescheduled. As many parts of our country experience first and second waves of this pandemic, our framework may serve as a resource for other centers experiencing restrictions on the scheduling of elective urologic surgeries.
As the COVID-19 pandemic started and peaked in New York, almost all of our scheduled urologic surgeries were cancelled. Each Urologist was asked to rank his/her cancelled surgeries by priority (Level 1-least urgent; Level 2-moderately urgent; Level 3-most urgent). A committee of Urologists assigned a subclass to Level 3 and 2 cases (3a-least urgent; 3b-moderately urgent; 3c-most urgent; 2a-lower priority; 2b-higher priority). The committee then reviewed cases by urgency to derive a final priority ranking.
A total of 478 total urologic surgeries were canceled and categorized: 250 Level 1, 130 Level 2, 98 Level 3 (73 adult, 25 pediatric). Level 3c involved renal cell carcinoma ≥ T2b, high-grade bladder urothelial carcinoma, adrenal mass/cancer > 6 cm, testicular cancer requiring radical orchiectomy, and penile cancer. Level 3b involved T2a renal masses requiring nephrectomy, while high-risk prostate cancer and symptomatic nephrolithiasis were classified as 3a. Level 2 included testicular cancer requiring retroperitoneal lymph node dissection and complicated benign prostatic hyperplasia. Surgeries for urologic reconstruction, non-complicated nephrolithiasis, erectile dysfunction, and urinary incontinence were considered Level 1.
Our disease-specific approach to surgical rescheduling offers appropriate guidance for triaging urologic surgeries. Our system can provide guidance to other institutions as COVID-19 cases surge in different regions and with the growing second wave.
2020 年 3 月，COVID-19 疫情的第一波浪潮迫使我们在纽约布朗克斯的医疗系统几乎取消了所有预定的手术。我们制定了一个泌尿科手术延期的优先排序框架，一旦病例允许重新安排，该框架就会被利用。随着我国许多地区经历着这一疫情的第一波和第二波，我们的框架可能为其他面临选择性泌尿科手术安排限制的中心提供资源。
随着 COVID-19 疫情在纽约开始并达到高峰，我们几乎所有的预定泌尿科手术都被取消了。每位泌尿科医生都被要求根据优先级对他们的取消手术进行排名（1 级-最不紧急；2 级-中度紧急；3 级-最紧急）。一个泌尿科医生委员会将 3 级和 2 级病例分为亚类（3a-最不紧急；3b-中度紧急；3c-最紧急；2a-较低优先级；2b-较高优先级）。然后，委员会根据紧迫性审查病例，得出最终的优先级排序。
共取消了 478 例泌尿科手术，并进行了分类：1 级 250 例，2 级 130 例，3 级 98 例（成人 73 例，儿童 25 例）。3c 级包括肾细胞癌≥T2b、高级别膀胱尿路上皮癌、肾上腺肿块/癌症>6cm、需要根治性睾丸切除术的睾丸癌和阴茎癌。3b 级包括需要肾切除术的 T2a 肾肿块，而高危前列腺癌和症状性肾结石被归类为 3a。2 级包括需要腹膜后淋巴结清扫术的睾丸癌和复杂的良性前列腺增生症。泌尿科重建、非复杂肾结石、勃起功能障碍和尿失禁手术被视为 1 级。
我们对手术重新安排的特定疾病方法为泌尿科手术的分诊提供了适当的指导。随着 COVID-19 病例在不同地区激增和第二波疫情的发展，我们的系统可以为其他机构提供指导。
