COVID-19 pandemic impact on clinical outcomes of patients with obstructive pyelonephritis
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UROLOGY - ORIGINAL PAPER
COVID‑19 pandemic impact on clinical outcomes of patients with obstructive pyelonephritis André B. Silva1 · Gustavo Freschi1 · Raphael V. Carrera1 · Rafael H. Astolfi1 · Fernando F. Berti1 · Nelson Gattas1 · Alex Meller1 Received: 10 September 2020 / Accepted: 3 November 2020 © Springer Nature B.V. 2020
Abstract Purpose Obstructive pyelonephritis is a common urologic emergency that requires prompt decompression of the collecting system. The COVID-19 pandemic has changed patient flow and healthcare strategies at numerous emergency departments across Brazil with still unknown consequences for the population. This study sought to investigate the impact of the COVID19 outbreak on clinical outcomes in patients with acute obstructive pyelonephritis at a tertiary academic center. Materials and methods After Institutional Review Board approval, a retrospective chart review of patients who required decompression of the collecting system due to acute obstructive pyelonephritis from June 2019 to July 2020 was conducted. Basic demographic information, pre-operative, and peri-operative data were recorded. Patients were assigned in “Pre-Covid” and “Post-Covid” groups based on the admission dates. Results A total of 63 patients were included, with 40 patients in the Pre-Covid group and 23 in the Post-Covid group. Patients from the Post-Covid group presented at the ER later after symptoms onset (7.8 vs. 4.3 days; p = 0.012), had higher rates of SIRS (57% vs. 25%; p = 0.012), perirenal abscesses (13% vs. 0%; p = 0.019), overall complications (p = 0.047) and presented longer hospital length of stay (7.6 vs. 3.8; p = 0.007). Conclusion During the COVID-19 pandemic, patients with acute obstructive pyelonephritis presented later for evaluation at the ER, had higher disease severity and longer hospital length of stay when compared to the pre-COVID group of patients with the same pathology. Keywords Pyelonephritis · Coronavirus infection · Indwelling catheter · Systemic inflammatory response syndrome Abbreviations OPN Obstructive pyelonephritis ICU Intensive care unit ER Emergency room COVID-19 Coronavirus disease SIRS Systemic inflammatory response syndrome qSOFA Quick sepsis-related organ failure assessment DJ Double-J stent
* Alex Meller [email protected] 1
Department of Urology, Endourology Division, Federal University of São Paulo, Rua Napoleão de Barros, 715, 2nd floor, São Paulo, SP 04024‑002, Brazil
Introduction Obstructive pyelonephritis (OPN) is a very common clinical condition in urological practice [1], with high rates of sepsis and Intensive Care Unit (ICU) admissions [2, 3], leading to prolonged hospital length of stay and an overall mortality of 2% [4, 5]. Obstructive pyelonephritis is an emergency, where targeted treatment [6, 7] and prompt decompression of the collecting system [8, 9] can potentially improve clinical outcomes, with a high impact on patient morbidity and mortality [10, 11]. Concerns about the SARS-CoV-2 pandemic have been raised due to its high infectiousn
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