Safety of “hot” and “cold” site admissions within a high‐volume urology department in the United Kingdom at the peak of the COVID‐19 pandemic

  1. Luke Stroman
  2. Beth Russell
  3. Pinky Kotecha
  4. Anastasia Kantartzi
  5. Luis Ribeiro
  6. Bethany Jackson
  7. Vugar Ismaylov
  8. Adeoye Oluwakanyinsola Debo‐Aina
  9. Findlay MacAskill
  10. Francesca Kum
  11. Meghana Kulkarni
  12. Raveen Sandher
  13. Anna Walsh
  14. Ella Doerge
  15. Katherine Guest
  16. Yamini Kailash
  17. Nick Simson
  18. Cassandra McDonald
  19. Elsie Mensah
  20. Li June Tay
  21. Ramandeep Chalokia
  22. Sharon Clovis
  23. Elizabeth Eversden
  24. Jane Cossins
  25. Jonah Rusere
  26. Grace Zisengwe
  27. Louisa Fleure
  28. Leslie Cooper
  29. Kathryn Chatterton
  30. Amelia Barber
  31. Catherine Roberts
  32. Thomasia Azavedo
  33. Jeffrey Ritualo
  34. Harold Omana
  35. Liza Mills
  36. Lily Studd
  37. Oussama El Hage
  38. Rajesh Nair
  39. Sachin Malde
  40. Arun Sahai
  41. Archana Fernando
  42. Claire Taylor
  43. Benjamin Challacombe
  44. Ramesh Thurairaja
  45. Rick Popert
  46. Jonathon Olsburgh
  47. Paul Cathcart
  48. Christian Brown
  49. Marios Hadjipavlou
  50. Ella Di Benedetto
  51. Matthew Bultitude
  52. Jonathon Glass
  53. Tet Yap
  54. Rhana Zakri
  55. Majed Shabbir
  56. Susan Willis
  57. Kay Thomas
  58. Tim O’Brien
  59. Muhammad Shamim Khan
  60. Prokar Dasgupta

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Abstract

Objectives

To determine the safety of urological admissions and procedures during the height of the COVID‐19 pandemic using “hot” and “cold” sites. The secondary objective is to determine risk factors of contracting COVID‐19 within our cohort.

Patients and methods

A retrospective cohort study of all consecutive patients admitted from March 1 to May 31, 2020 at a high‐volume tertiary urology department in London, United Kingdom. Elective surgery was carried out at a “cold” site requiring a negative COVID‐19 swab 72‐hours prior to admission and patients were required to self‐isolate for 14‐days preoperatively, while all acute admissions were admitted to the “hot” site.

Complications related to COVID‐19 were presented as percentages. Risk factors for developing COVID‐19 infection were determined using multivariate logistic regression analysis.

Results

A total of 611 patients, 451 (73.8%) male and 160 (26.2%) female, with a median age of 57 (interquartile range 44‐70) were admitted under the urology team; 101 (16.5%) on the “cold” site and 510 (83.5%) on the “hot” site. Procedures were performed in 495 patients of which eight (1.6%) contracted COVID‐19 postoperatively with one (0.2%) postoperative mortality due to COVID‐19. Overall, COVID‐19 was detected in 20 (3.3%) patients with two (0.3%) deaths. Length of stay was associated with contracting COVID‐19 in our cohort (OR 1.25, 95% CI 1.13‐1.39).

Conclusions

Continuation of urological procedures using “hot” and “cold” sites throughout the COVID‐19 pandemic was safe practice, although the risk of COVID‐19 remained and is underlined by a postoperative mortality.

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  1. ScreenIT

    SciScore for 10.1101/2020.08.04.20154203: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    One limitation of this study the possibility of under-reporting of post-operative COVID-19 infection as a result of patients presenting at other hospitals or sub-clinical infection in the community without presenting to hospital. Asymptomatic shedding of the virus can occur and may account for up to 60% of cases. (13) To limit this, the authors contacted surrounding hospitals where patients or doctors reported presentations in other sites, as is the case with the post-operative mortality reported. The observational nature of this study meant that the authors did not request patients to have routine post-operative COVID-19 PCR swabs which may have increased the number of post-operative infections detected. On the other hand, post-operative COVID-19 infection is not necessarily causative from the admission as COVID-19 could have been obtained in the community in patients discharged from care. In addition, the ‘cold’ site was not set up at the beginning of the time described and was a response to the pandemic, coming into effect on the 30th March 2020. However, the authors decided to include all patients in March 2020 as this gives a more rounded picture of the height of the pandemic. Not all patients at the ‘hot’ site were tested for COVID-19 on admission although all ‘cold’ site patients were. Routine testing on the ‘hot’ site changed through the time of the study, initially only symptomatic patients were being tested, while later all emergency admissions were tested. Due to t...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1002/bco2.56
  3. Version published to 10.1101/2020.08.04.20154203v1 on medRxiv