Septic and febrile kidney stone presentation during the COVID-19 pandemic at Nova Scotia Health Central Zone hospitals: What is the effect of lack of access to care during pandemic restrictions?
Jesse Spooner1, Kaveh Masoumi-Ravandi1, Gabriela Ilie1,2,3,4, Thomas Skinner1, Andrea G. Lantz Powers1.
1Department of Urology, Dalhousie University, Halifax, NS, Canada; 2Department of Community and Health Epidemiology, Dalhousie University, Halifax, NS, Canada; 3Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada; 4Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
Introduction: At the Nova Scotia Health hospitals in Halifax, a subjective increase in the number of septic/febrile patients requiring emergent stone therapy has been observed. This may be due to reductions in elective surgeries and limited access to laboratory tests, such as urinalysis and culture. This study examines the volume and severity of septic stone patients requiring emergent intervention amidst the COVID-19 pandemic healthcare restrictions.
Methods: In this retrospective, single-center, observational study, we reviewed the charts of all urgent or emergent septic stone patients requiring ureteral stent insertion from August 2019 to January 2020 (pre-COVID cohort) and August 2020 to January 2021 (intra-COVID cohort). The primary outcome was the number of patients requiring stenting. The secondary outcome included the number of patients classified as emergency status as per the American Society of Anesthesiologists (ASA) classification.
Results: The number of septic stone presentations increased by approximately 17% during the COVID pandemic (24 patients pre-COVID vs. 28 patients intra-COVID). There was an increase in patients classified as emergency (ASA) of approximately 62% (13 patients pre-COVID vs. 21 patients intra-COVID). The pre-COVID timeframe showed a predominance of women (n=18) compared to men (n=6), similar to the intra-COVID cohort, demonstrating 21 females and seven men. The mean age for the pre- and intra-COVID cohorts were 60.1 and 59.9 years, respectively.
Conclusions: An increased number of patients required ureteral stent insertion for septic kidney stones during COVID-related reductions in healthcare. The number of patients classified as an emergency procedure (ASA classifciation) increased. The exact cause is unknown but during this timeframe, there was delayed urological followup, lack of access to primary care, deferred elective treatment, limited access to lab esting, and a reluctance by patients to seek medical care due to fear of exposure to COVID-19.
