2019冠状病毒病大流行期间接受泌尿外科择期手术患者的围手术期结局：意大利28家机构的全国概况
Perioperative outcomes of patients undergoing urological elective surgery during the COVID-19 pandemic: a national overview across 28 Italian institutions.
作者信息
Minervini Andrea, Di Maida Fabrizio, Mari Andrea, Porreca Angelo, Rocco Bernardo, Celia Antonio, Bove Pierluigi, Umari Paolo, Volpe Alessandro, Galfano Antonio, Pastore Antonio Luigi, Annino Filippo, Parma Paolo, Greco Francesco, Nucciotti Roberto, Schiavina Riccardo, Esposito Fabio, Romagnoli Daniele, Leonardo Costantino, Falabella Roberto, Gallo Fabrizio, Amenta Michele, Sciorio Carmine, Verze Paolo, Tafuri Alessandro, Pucci Luigi, Varca Virginia, Zaramella Stefano, Pagliarulo Vincenzo, Bozzini Giorgio, Ceruti Carlo, Falsaperla Mario, Cafarelli Angelo, Antonelli Alessandro
机构信息
Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy.
Department of Oncological Urology - Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy.
出版信息
Cent European J Urol. 2021;74(2):259-268. doi: 10.5173/ceju.2021.0374. Epub 2021 Apr 22.
INTRODUCTION
The aim of this study was to assess the safety of elective urological surgery performed during the pandemic by estimating the prevalence of COVID-19-like symptoms in the postoperative period and its correlation with perioperative and clinical factors.
MATERIAL AND METHODS
In this multicenter, observational study we recorded clinical, surgical and postoperative data of consecutive patients undergoing elective urological surgery in 28 different institutions across Italy during initial stage of the COVID-19 pandemic (between February 24 and March 30, 2020, inclusive).
RESULTS
A total of 1943 patients were enrolled. In 12%, 7.1%, 21.3%, 56.7% and 2.6% of cases an open, laparoscopic, robotic, endoscopic or percutaneous surgical approach was performed, respectively. Overall, 166 (8.5%) postoperative complications were registered, 77 (3.9%) surgical and 89 (4.6%) medical. Twenty-eight (1.4%) patients were readmitted to hospital after discharge and 13 (0.7%) died. In the 30 days following discharge, fever and respiratory symptoms were recorded in 101 (5.2%) and 60 (3.1%) patients. At multivariable analysis, not performing nasopharyngeal swab at hospital admission (HR 2.3; CI 95% 1.01-5.19; p = 0.04) was independently associated with risk of developing postoperative medical complications. Number of patients in the facility was confirmed as an independent predictor of experiencing postoperative respiratory symptoms (p = 0.047, HR:1.12; CI95% 1.00-1.05), while COVID-19-free type of hospitalization facility was a strong independent protective factor (p = 0.02, HR:0.23, CI95% 0.07-0.79).
CONCLUSIONS
Performing elective surgery during the COVID-19 pandemic does not seem to affect perioperative outcomes as long as proper preventive measures are adopted, including nasopharyngeal swab before hospital admission and hospitalization in dedicated COVID-19-free facilities.
引言
本研究旨在通过评估术后新冠病毒疾病样症状的发生率及其与围手术期和临床因素的相关性，来评估在疫情期间进行的择期泌尿外科手术的安全性。
材料与方法
在这项多中心观察性研究中，我们记录了在意大利28个不同机构中，于新冠疫情初期（2020年2月24日至3月30日，含当日）接受择期泌尿外科手术的连续患者的临床、手术及术后数据。
结果
共纳入1943例患者。分别有12%、7.1%、21.3%、56.7%和2.6%的病例采用了开放、腹腔镜、机器人、内镜或经皮手术入路。总体而言，记录到166例（8.5%）术后并发症，其中77例（3.9%）为手术相关并发症，89例（4.6%）为医疗相关并发症。28例（1.4%）患者出院后再次入院，13例（0.7%）死亡。出院后30天内，101例（5.2%）患者出现发热，60例（3.1%）患者出现呼吸道症状。多变量分析显示，入院时未进行鼻咽拭子检测（HR 2.3；95%CI 1.01 - 5.19；p = 0.04）与术后发生医疗并发症的风险独立相关。机构内患者数量被确认为术后出现呼吸道症状的独立预测因素（p = 0.047，HR：1.12；95%CI 1.00 - 1.05），而无新冠病毒疾病的住院机构类型是一个强有力的独立保护因素（p = 0.02，HR：0.23，95%CI 0.07 - 0.79）。
结论
在新冠疫情期间进行择期手术，只要采取适当的预防措施，包括入院前鼻咽拭子检测以及在专门的无新冠病毒疾病设施中住院，似乎不会影响围手术期结果。
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