Ratajczak JM. et al., 2022: Can We Identify Patients in Danger of Delayed Treatment? Management of COVID-19 Pandemic Backlog in Urology Care in Poland.
Ratajczak JM, Gawrońska A, Fischer M, Hladun T, Marczak M.
Department of Management and Logistics in Health Care, Medical University of Lodz, 90-647 Lodz, Poland.
Łukasiewicz Research Network, Poznań Institute of Technology, 61-755 Poznań, Poland.
Faculty of Pharmacy, Medical University of Gdansk, 80-210 Gdansk, Poland.
Urology Department, Regional Specialized Hospital in Nowa Sól, 67-100 Nowa Sól, Poland.
The COVID-19 pandemic had a tremendous impact on healthcare systems around the world. This study aims to research the course of surgical treatment in urology during the pandemic in 2020, evaluate the volume of deferred treatment in urology in Poland, and indicate groups of patients that are especially vulnerable to a delay in the delivery of healthcare services. The National Health Found statistics (NHF) database was searched for information on procedures completed in urology departments from 2015 to 2020. Changes in hospital discharges of adults from 2019 to 2021 were investigated using monthly reports of NHF on patient billing groups. Statistics of PSA, testosterone, and creatinine testing were extracted from NHF reports. Annual changes in the number of surgeries were calculated. Then, the estimation of the expected quantity of procedures without the occurrence of the pandemic was performed using linear regression based on data from 2015 to 2020. The estimation was assumed reliable at R2 > 0.8. The difference between collected and estimated data was analysed. In 2020, the volume of radical prostatectomies, cystectomies, and kidney surgeries noted downturns following lockdowns in March and November. All analysed procedures, except radical cystectomy, noted a reduction in the entire year. The declines reached -34% in shockwave lithotripsy, -13% in ureterorenoscopic lithotripsy, -22% in cystolithotripsy, -28% in percutaneous lithotripsy, -12% in transurethral resection of a bladder tumour (TURBT), -31% in transurethral resection of the prostate, -15% in nephrectomy and kidney tumorectomy, and -10% in radical prostatectomy. Among the analysed procedures, only radical cystectomy rates increased 5%. Prostate-specific antigen and creatinine tests fell -17%, and testosterone testing was down -18%. In conclusion, the patients most vulnerable to delayed treatment due to the post-pandemic backlog are those requiring TURBT, kidney cancer operations, and radical prostatectomies. Solving backlogs in urology should prioritise cancer patients and thus requires improved access to cystoscopy, TURBT, diagnoses and surgery of prostate and kidney tumours. Addressing the needs of patients suffering from benign diseases demands appropriate measures to increase the surgical productivity of urology departments.
Int J Environ Res Public Health. 2022 Dec 9;19(24):16547. doi: 10.3390/ijerph192416547.PMID: 36554427
The discussion reflects how urologists obscure the value of ESWL: “The SWL rates dropped by 34%, which was more than expected. … As a long haul consequence, this may lead to some patients potentially having invasive procedures such as URSL in the future due to stones becoming symptomatic or too large for shock wave treatment.” Assuming that the Polish urologists had a choice to choose the least invasive procedure ESWL, not occupying hospital beds, without anaesthesia, without the risk of intensive care, it is difficult to understand why from 2019 to 2020 ESWL was reduced by 34% from 15,499 in 2091 to 10,209 in 2020. Based on the general reduction of ESWL in recent years the expected case number reduction was calculated as 18%. It is likely that other reasons, than pure patient care governed the decision. That different decisions could have been possible was nicely demonstrated in a publication from Great Britain on the same topic (1).
1 Young MJ, Pang KH, Elmussarah M, Hughes PF, Browning AJ, Symons SJ. Acute extracorporeal shockwave lithotripsy for ureteric stones - 7-years' experience from a busy district general hospital. BJU Int. 2022 Nov;130(5):655-661. doi: 10.1111/bju.15820. Epub 2022 Jun 27. PMID: 35689415.