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

Background

Contracting COVID-19 peri-operatively has been associated with a mortality rate as high as 23%, making prevention vital.

Objectives

The primary objective is to determine safety of surgical 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.

Design, Setting and Participants

A retrospective cohort study of all consecutive patients admitted from 1st March – 31st May 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 to self-isolate for 14 days pre-operatively, whilst all acute admissions were admitted to the ‘hot’ site.

Outcome Measurements and Statistical Analysis

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

Results and Limitations

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 8 (1.6%) contracted COVID-19 post-operatively with 1 (0.2%) post-operative mortality due to COVID-19. Overall, COVID-19 was detected in 20 (3.3%) patients with 2 (0.3%) deaths. Length of stay was associated with contracting COVID-19 in our cohort (OR 1.25, 95% CI 1.13-1.39). Limitations include possible under reporting due to post-operative patients presenting elsewhere.

Conclusions

Continuation of surgical 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 post-operative mortality.

Patient Summary

Using ‘hot’ and ‘cold’ sites has allowed the safe continuation of urological practice throughout the height of the COVID-19 pandemic.

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