Martini‐Klinik experience of prostate cancer surgery during the early phase of the COVID‐19 pandemic

Abstract

In order to restrain the uncontrolled spread of the 2019 coronavirus, COVID-19, and to provide sufficient intensive care unit (ICU) capacity, medical specializations needed to develop new routines and risk strategy protocols. Those restrictions have also impacted the urological community. Several medical organizations have developed specific information hubs, blogs and resource centres focused on how to tackle the COVID-19 situation [1-3]. Although the German Society of Urology (Deutsche Gesellschaft für Urologie) published a recommendation to evaluate the need for timely therapy in patients with prostate cancer (PCa) according to D’Amico risk groups on 2 April 2020, to date there have been no compulsory directives regarding omitting radical prostatectomy during the COVID-19 pandemic. The Martini-Klinik Prostate Cancer Centre (MK) at the University Hospital Hamburg-Eppendorf (UHH) continued to perform surgery for PCa with risk-adjusted special precautions. In the present study, we share our initial experiences, routines and results of treating patients in the early phase of the COVID-19 pandemic. After approval of the study by our institutional review board, we performed a retrospective analysis of patient and preoperative tumour characteristics, and short-term complications of patients with PCa undergoing radical prostatectomy at our institution before and during the early phase of the COVID-19 pandemic in Germany. One group represented a consecutive cohort of patients with PCa treated in the period after the first COVID-19 case at UHH was detected (27 February 2020 to 17 April 2020), while the second group represented consecutive patients treated in the period before the first COVID-19 case (1 January to 26 February 2020). We evaluated the possible short-term postoperative complications and circumstances that occurred in relation to COVID-19. Putative factors that would predispose patients to a potentially worse outcome in case of infection or that increased the probability of being dependent on postoperative ICU care (focusing on patient age, cardiovascular disease and hypertension, obstructive sleep apnoea syndrome, diabetes mellitus, chronic lung, kidney or liver disease, and severe obesity) were assessed by evaluation of patient history. All analysed patients gave their informed consent for data analysis. All clinical and patient data were stored in a secured and pseudonymized database in the MK. In close communication with the official German public health institute, the Robert-Koch Institute (RKI) [4], a task force defined the procedures and safety measures required for all sections of the UHH, thus including the MK, since the first COVID-19 patient was identified in Germany. In addition to being physically ‘disconnected’ from the main complex of the UHH and offering only one- and two-bed rooms, thus benefiting from certain advantages in terms of infection control, further measures were established in the MK in concordance with the task force. No COVID-19 testing was routinely performed prior to surgery; however, before hospital admission and again prior to surgery, patients were repeatedly asked about COVID-19 exposure or symptoms (see Appendix S1). Patients with potential COVID-19 exposure were only admitted after a symptom-free period of >14 days and negative testing. Further COVID-19 measures undertaken by the UHH task force and the MK are shown in Fig. 1. Descriptive statistics of categorical variables are given as frequencies and proportions. Medians and interquartile ranges (IQR) are reported for continuously coded variables. For all statistical analyses, R software environment for statistical computing (version 3.4.3) was used. All tests were two-sided, with a level of statistical significance set at P < 0.05. We compared the results of 447 patients treated prior to the COVID-19 pandemic with those of 337 patients treated during the early phase of COVID-19. Patient characteristics, including preoperative tumour