Methodology for the Triage of Urologic Surgical Cases in the Setting of a Pandemic

Purpose: The COVID-19 pandemic forced our healthcare system in the Bronx, New York to cancel nearly all surgeries. With the possible second wave approaching, we developed a framework for the prioritization of Urologic surgeries that can be used as a model for those experiencing surges elsewhere. Methods: Each surgeon in the department was asked to rank their cancelled surgeries by priority (Level 1 – least urgent; Level 2 – moderately urgent; Level 3 – most urgent). A committee of urologists assigned a subclass to Level 3 and 2 cases (3a – least urgent; 3b – moderately urgent; 3c – most urgent; 2a – lower priority; 2b – higher priority). The committee then reviewed cases by urgency to arrive on a final priority ranking. Results: A total of 478 total cases were categorized: 250 Level 1, 130 Level 2, 98 Level 3 (73 adult, 25 pediatric). Level 3c involved renal cell carcinoma ≥ T2b, high-grade bladder urothelial carcinoma, adrenal mass/cancer > 6 cm, testicular cancer requiring radical orchiectomy, and penile cancer. Level 3b involved T2a renal masses requiring nephrectomy; high-risk prostate cancer and symptomatic nephrolithiasis were classified as 3a. Level 2 included testicular cancer requiring retroperitoneal lymph node dissection and complicated benign prostatic hyperplasia. Surgeries for urologic reconstruction, erectile dysfunction, and incontinence were considered Level 1. Conclusions: Our disease-specific approach to surgical rescheduling offers appropriate guidance for triaging Urologic surgeries. Our system can provide guidance to other institutions as COVID-19 surges in different regions and with the growing possibility of a second wave.