Exploring Urological Experience in the COVID-19 Outbreak: American Confederation of Urology (CAU) Survey

ABSTRACT Purpose: To explore the current situation faced by Latin American urology departments during the COVID-19 Outbreak in terms of knowledge, actions, prioritization of urology practices, and implementation of internal clinical management protocols for inpatients and outpatients. Material and Methods: A non-validated, structured, self-administered, electronic survey with 35 closed multiple choice questions was conducted in Spanish, Portuguese, Italian, and English and Deutsch versions from April 1st to April 30th, 2020. The survey was distributed through social networks and the official American Confederation of Urology (CAU) website. It was anonymous, mainly addressed to Latin American urologists and urology residents. It included 35 questions exploring different aspects: 1) Personal Protective Equipment (PPE) and internal management protocols for healthcare providers; 2) Priority surgeries and urological urgencies and 3) Inpatient and outpatient care. Results: Of 864 surveys received, 846 had at least 70% valid responses and were included in the statistical analyses. Surveys corresponded to South America in 62% of the cases, Central America and North America in 29.7%. 12.7% were residents. Regarding to PPE and internal management protocols, 88% confirmed the implementation of specific protocols and 45.4% have not received training to perform a safe clinical practice; only 2.3% reported being infected with COVID-19. 60.9% attended urgent surgeries. The following major uro-oncologic surgeries were reported as high priority: Radical Nephrectomy (RN) 58.4%, and Radical Cystectomy (RC) 57.3%. When we associate the capacity of hospitalization (urologic beds available) and percentage of high-priority surgery performed, we observed that centers with fewer urological beds (10-20) compared to centers with more urological beds (31-40) performed more frequently major urologic cancer surgeries: RN 54.5% vs 60.8% (p=0.0003), RC 53.1% vs 64.9% (p=0.005) respectively. Conclusions: At the time of writing (May 13th 2020) our data represents a snapshot of COVID-19 outbreak in Latin American urological practices. Our findings have practical implications and should be contextualized considering many factors related to patients and urological care: The variability of health care scenarios, institutional capacity, heterogeneity and burden of urologic disease, impact of surgical indications and decision making when prioritizing and scheduling surgeries in times of COVID-19 pandemic.

摘要

目的：探讨新型冠状病毒肺炎（COVID-19）疫情期间，拉丁美洲泌尿外科科室在知识储备、临床举措、泌尿外科诊疗优先级制定，以及住院与门诊患者内部临床管理方案落实方面所面临的现状。

材料与方法：本研究于2020年4月1日至4月30日期间，针对西班牙语、葡萄牙语、意大利语、英语及德语版本，开展了一项未经效度验证的结构化自填式电子问卷调研，问卷共包含35道封闭式多选题。调研通过社交网络及美国泌尿外科学会（American Confederation of Urology, CAU）官方网站进行分发，采用匿名形式，主要面向拉丁美洲泌尿外科医师及住院医师。问卷涵盖三大维度的调研内容：1）医疗人员个人防护装备（Personal Protective Equipment, PPE）与内部管理方案；2）优先实施手术及泌尿外科急诊情况；3）住院与门诊诊疗服务。

结果：本次调研共回收问卷864份，其中846份的有效应答率不低于70%，被纳入统计分析。按地域分布来看，62%的受访者来自南美，29.7%来自中美洲及北美，12.7%为住院医师。在医疗人员个人防护与内部管理方案方面，88%的受访者确认已落实针对性管理方案，但45.4%的人员未接受过安全临床实践相关培训；仅2.3%的受访者报告曾感染新型冠状病毒肺炎。60.9%的医师参与了急诊手术。本次调研中，优先级较高的主要泌尿肿瘤手术包括：根治性肾切除术（Radical Nephrectomy, RN）占比58.4%，根治性膀胱切除术（Radical Cystectomy, RC）占比57.3%。进一步分析住院收治能力（可使用的泌尿外科床位）与优先手术开展占比的关联后发现，相较于泌尿外科床位较多的中心（31~40张），床位较少的中心（10~20张）更频繁地开展大型泌尿肿瘤手术：根治性肾切除术分别为54.5%与60.8%（p=0.0003），根治性膀胱切除术分别为53.1%与64.9%（p=0.005）。

结论：在本研究撰写之时（2020年5月13日），本研究数据呈现了新型冠状病毒肺炎疫情期间拉丁美洲泌尿外科临床实践的即时快照。本研究结果具备实践指导意义，解读时需结合与患者及泌尿外科诊疗相关的多项因素：包括医疗场景的差异性、医疗机构的服务能力、泌尿疾病的异质性与疾病负担，以及疫情期间制定手术优先级与排期时的手术指征与决策制定所带来的影响。