Durand M, Bentellis I, Barthe F, Tibi B, Shaikh A, Mellouki A, Berthet J-P, Legueult K, Pradier C, Piche T, Ahallal Y, Chevallier D
Service d'urologie, andrologie, transplantation rénale, hôpital Pasteur 2, France; Inserm U1081 - CNRS UMR 7284, université de Nice Côte d'Azur, France.
Service d'urologie, andrologie, transplantation rénale, hôpital Pasteur 2, France.
Prog Urol. 2021 Oct;31(12):716-724. doi: 10.1016/j.purol.2021.02.007. Epub 2021 Feb 27.
Faced with the first wave of Covid-19 pandemic, guidelines for surgical triage were developed to free up healthcare resources. The aim of our study was to assess clinical characteristics and surgical outcomes of triaged patients during the first Covid-19 crisis.
We conducted a cohort-controlled, non-randomized, study in a University Hospital of south-eastern France. Data were collected prospectively from consecutive patients after triage during the period from March 15th to May 1st and compared with control data from outside pandemic period. Primary endpoint was intensive care unit (ICU) admissions for surgery-related complications. Rates of surgery-specific death, postponed operations, positive PCR testing and Clavien-Dindo complications and data from cancer and non- cancer subgroups were assessed.
After triage, 96 of 142 elective surgeries were postponed. Altogether, 71 patients, median age 68 y.o (IQR: 56-75 y.o), sex ratio M/F of 4/1, had surgery, among whom, 48 (68%) had uro-oncological surgery. No patients developed Covid-19 pneumonia in the post-surgery period. Three (4%) were admitted to the ICU, one of whom died from multi-organ failure due to septic shock caused by klebsiella pneumonia following a delay in treatment. Three Covid-19 RT-PCR were done and all were negative. There was no difference in mortality rates or ICU admission rates between control and Covid- era patients.
Surgery after triage during the first Covid-19 pandemic was not associated with worse short-term outcomes. Urological cancers could be operated on safely in our context but delays in care for aggressive genitourinary diseases could be life threatening.
面对新冠疫情的第一波冲击，制定了手术分诊指南以释放医疗资源。我们研究的目的是评估在首次新冠危机期间分诊患者的临床特征和手术结果。
我们在法国东南部的一家大学医院进行了一项队列对照、非随机研究。前瞻性收集了3月15日至5月1日期间分诊后连续患者的数据，并与疫情期间以外的对照数据进行比较。主要终点是因手术相关并发症入住重症监护病房（ICU）。评估了手术特异性死亡率、延期手术率、PCR检测阳性率、Clavien-Dindo并发症以及癌症和非癌症亚组的数据。
分诊后，142例择期手术中有96例被推迟。共有71例患者接受了手术，中位年龄68岁（四分位间距：56 - 75岁），男女比例为4/1，其中48例（68%）接受了泌尿肿瘤手术。术后无患者发生新冠肺炎。3例（4%）入住ICU，其中1例因肺炎克雷伯菌引起的感染性休克导致多器官衰竭，治疗延误后死亡。进行了3次新冠RT-PCR检测，结果均为阴性。对照组和新冠疫情期间患者的死亡率或ICU入住率无差异。
在首次新冠疫情期间分诊后的手术与较差的短期结局无关。在我们的情况下，泌尿生殖系统癌症手术可以安全进行，但侵袭性泌尿生殖系统疾病的治疗延误可能危及生命。
3级。
