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
Authors: Stroman Luke , Russell Beth , Kotecha Pinky , Kantartzi Anastasia , Ribeiro Luis , Jackson Bethany , Ismaylov Vugar , Debo-Aina Adeoye Oluwakanyinsola , MacAskill Findlay , Kum Francesca , Kulkarni Meghana , Sandher Raveen , Walsh Anna , Doerge Ella , Guest Katherine , Kailash Yamini , Simson Nick , McDonald Cassandra , Mensah Elsie , Tay Li June , Chalokia Ramandeep , Clovis Sharon , Eversden Elizabeth , Cossins Jane , Rusere Jonah , Zisengwe Grace , Fleure Louisa , Cooper Leslie , Chatterton Kathryn , Barber Amelia , Roberts Catherine , Azavedo Thomasia , Ritualo Jeffrey , Omana Harold , Mills Liza , Studd Lily , Hage Oussama El , Nair Rajesh , Malde Sachin , Sahai Arun , Fernando Archana , Taylor Claire , Challacombe Benjamin , Thurairaja Ramesh , Popert Rick , Olsburgh Jonathon , Cathcart Paul , Brown Christian , Hadjipavlou Marios , Benedetto Ella Di , Bultitude Matthew , Glass Jonathon , Yap Tet , Zakri Rhana , Shabbir Majed , Willis Susan , Thomas Kay , O’Brien Tim , Khan Muhammad Shamim , Dasgupta Prokar 
Published: August 2020

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.