Evidence and rationale for a pragmatic approach to pre-operative isolation prior to elective urological surgery during the de-escalation phase of COVID-19

Abstract

Introduction: In response to the COVID-19 pandemic elective operating decreased to meet critical care capacity demands at the Royal Berkshire Hospital. As this demand fell elective operating subsequently increased. This saw the introduction of the ‘Cold Pathway’ at the Royal Berkshire Hospital in line with Public Health England guidelines; the first urology patients being admitted on 14 May 2020. This requires patients to undergo a 14-day self-isolation period, which many find difficult, with a negative COVID-19 swab 48 h prior to their operation. Aims: This article examines whether any differences exist in patient outcomes related to COVID-19 since implementation of the Cold Pathway and the significance of this to the 14-day self-isolation rule. Methods: Urology patients electively operated on between 23 March 2020–3 July 2020 were included. A combination of electronic records and telephone consultations were used to obtain data regarding a pre-selected set of questions. Results: One hundred and ninety-six patients were included. Seventy-eight patients were admitted prior to the introduction of the Cold Pathway and 118 after this point. Of patients analysed prior to the implementation of the Cold Pathway, one required ongoing hospital treatment as a result of potentially obtaining COVID-19 from in-patient admission. Of the 78 patients, 14 isolated prior to their procedure. Post-implementation, 118 patients were examined. Despite claiming to have complied with self-isolation instructions at admission, 45 patients admitted retrospectively to not complying at all or only partially. One patient developed COVID-19 3 weeks post-operatively. Discussion: We have shown no difference in outcomes, in relation to COVID-19, when comparing those admitted pre- and post-Cold Pathway implementation. Many patients describe difficulty in following this isolation period. In conjunction with falling national and local levels of COVID-19 positive cases, we have therefore adopted a more pragmatic approach to patient isolation with the ability to perform operations based on clinical need and individual patient circumstances. Level of evidence: This is a cohort study of patients undergoing elective urological surgery at the Royal Berkshire Hospital.