How the COVID-19 wave changed emergency urology: results from an academic tertiary referral hospital in the epicenter of the Italian red zone

Objectives: To quantify and characterize the burden of urological patients admitted to emergency department (ED) in Lombardy during Italian COVID-19 outbreak, comparing it to a reference population from 2019. Methods: We retrospectively analyzed all consecutive admissions to ED from 1st January to 9thApril, in both 2019 and 2020. According to the ED discharge ICD-9-CM code, patients were grouped in urological and respiratory patients. We evaluated the type of access (self-presented/ambulance), discharge priority code, ED discharge (hospitalization, home), need for urological consultation or urgent surgery. Results: The number of urological diagnoses in ED was inversely associated to COVID-19 diagnoses (CI 95% -0.41/-0.19; Beta=-0.8; p<0.0001). The average access per day was significantly lower after 10th March 2020 (1.5±1.1 vs 6.5±2.6; p<0.0001), compared to reference period. From 11th March 2020, the inappropriate admissions to ED were reduced (10/45 vs 96/195; p=0.001). Consequently, the patients admitted were generally more demanding, requiring a higher rate of urgent surgeries (4/45 vs 4/195; p=0.02). This reflected in an increase of the hospitalization rate from 12.7% to 17.8% (Beta=0.88; p<0.0001) during 2020. Conclusions: Urological admissions to ED during lockdown differed from the same period of 2019 both qualitatively and quantitatively. The spectrum of patients seems to be relatively more critical, often requiring an urgent management. These patients may represent a challenge due to the difficult circumstances caused by the pandemic.