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| The impact of the coronavirus disease 2019 pandemic on elective urological procedures in Australia |
Athul Johna,*( ),Mustafa Mianb,Subhashaan Sreedharanb,Arman A. Kahokehra,c
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a Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
b Melbourne Medical School, University of Melbourne, St Albans, Melbourne, VIC, Australia
c Flinders University, Bedford Park, SA, Australia |
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Abstract Objective: To investigate the changes in elective private urological procedures in Australia during the coronavirus disease 2019 pandemic.
Methods: Data were extracted from publicly available datasets from Medicare Benefits Schedule using item numbers assigned to each commonly performed urological intervention. These procedures were divided into three groups: Oncological therapeutic, diagnostic, and non-oncological therapeutic procedures. A smoothing model, based on the historic procedure numbers from 2017 to 2019, was used to forecast monthly number of procedures performed in each category between January 2020 and June 2020. These forecasted models were compared with reported figures.
Results: A total of 108 169 procedures were performed between January 2020 and June 2020 based on the Medicare Benefits Schedule item numbers listed. There was a significant reduction (percentage change) in total procedures performed in April 2020 (-22.6%, 95% confidence interval [CI]: -28.7% to -15.4%) and May 2020 (-33.2%, 95% CI: -37.5% to -28.3%). There was a significant reduction in oncological therapeutic, non-oncological therapeutic, and diagnostic procedures performed in April 2020 and May 2020 (p<0.05). These numbers did not include procedures performed in public sector.
Conclusion: There was a significant reduction in total urological procedures (including diagnostic, oncological, and non-oncological) performed in months of April 2020 and May 2020 during time of federal restrictions. Both public and private healthcare sectors need to be supported in the upcoming months to prevent further delays in treatment and poorer clinical outcomes.
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Received: 17 December 2020
Available online: 20 January 2022
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Corresponding Authors:
Athul John
E-mail: atuljohn@gmail.com
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Total urological procedures in Australia between January 2017 and June 2020. (A) Observed total procedures between January 2017 and June 2020, modelled total procedures between January 2017 and December 2019, and predicted (with 95% CI) total procedures between January 2020 and June 2020. (B) Observed and predicted (with 95% CI) total procedures between January 2020 and June 2020. CI, confidence interval.
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| Date | Total procedure | Oncological therapeutic procedure | Diagnostic procedure | Non-oncological therapeutic procedures | | Absolute difference | Percentage difference (95% CI) | Absolute difference | Percentage difference (95% CI) | Absolute difference | Percentage difference (95% CI) | Absolute difference | Percentage difference (95% CI) | | Jan 2020 | 199 | 1.2 (-7.6, 11.8) | 59 | 3.0 (-8.4, 17.5) | 215 | 1.9 (-7.2, 12.9) | 1 | 0.0 (-9.2, 11.3) | | Feb 2020 | 796 | 3.9 (-3.6, 12.8) | 114 | 4.9 (-5.1, 17.2) | 766 | 5.4 (-2.4 14.4) | -29 | -0.8 (-8.9, 8.8) | | Mar 2020 | -807 | -3.7 (-10.3, 3.9) | -29 | -1.1 (-10.0, 9.6) | -541 | -3.5 (-10.1, 4.1) | -224 | -6.0 (-13.2, 2.5) | | Apr 2020 | -4233 | -22.6a (-28.7, -15.4) | -350 | -15.5a (-23.9, -5.2) | -3291 | -25.0a (-30.9, -18.0) | -532 | -16.5a (-23.8, -7.6) | | May 2020 | -7668 | -33.2a (-37.5, -28.3) | -734 | -27.0a (-33.1, -19.7) | -5430 | -33.3a (-37.6, -28.3) | -1442 | -36.2a (-40.8, -30.8) | | Jun 2020 | -374 | -1.9 (-9.1, 6.6) | 189 | 8.0 (-2.2, 20.5) | -331 | -2.3 (-9.5, 6.1) | -168 | -4.9 (-12.9, 4.7) |
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Monthly absolute and percentage differences between observed and predicted number of total procedures, oncological therapeutic procedures, diagnostic procedures, and non-oncological therapeutic procedures in Australia.
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Oncological therapeutic procedures in Australia between January 2017 and June 2020. (A) Observed oncological therapeutic procedures between January 2017 and June 2020, modelled oncological therapeutic procedures between January 2017 and December 2019, and predicted (with 95% CI) oncological therapeutic procedures between January 2020 and June 2020. (B) Observed and predicted (with 95% CI) oncological therapeutic procedures between January 2020 and June 2020. CI, confidence interval.
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| Procedure | Percentage difference (95% CI) | | Jan 2020 | Feb 2020 | Mar 2020 | Apr 2020 | May 2020 | Jun 2020 | | Oncological procedures | | Radical prostatectomy | 9.8 (-6.8, 33.5) | -2.8 (-15.6, 14.6) | -7.5 (-18.9, 7.6) | -10.2 (-22.7, 7.3) | -13.2 (-23.6, 0.4) | 16.9a (0.9, 39.0) | | Nephrectomy + nephroureterectomy | 21.9 (-0.8, 57.9) | 19.3 (-0.6, 49.1) | 6.1 (-11.4, 32.0) | -2.6 (-17.9, 19.7) | -33.6a (-43.8, -19.1) | -4.2 (-17.7, 14.6) | | Cystectomy | -15.0 (-34.9, 22.5) | 11.9 (-12.8, 56.0) | -2.2 (-23.4, 35.1) | 3.0 (-18.9, 41.0) | -13.0 (-29.9, 14.7) | 6.2 (-16.0, 44.2) | | Transurethral resection of bladder tumour | -4.4 (-16.4, 11.7) | -2.1 (-12.1, 10.5) | -4.6 (-13.8, 6.7) | -24.1a (-32.3, -13.7) | -36.7a (-42.3, -29.8) | -0.6 (-10.8, 12.4) | | Diagnostic procedures | | Biopsies of upper tract or bladder | -1.0 (-11.4, 12.2) | 4.5 (-4.9, 16.1) | -4.3 (-12.4, 5.5) | -9.4 (-18.1, 1.3) | -25.6a (-31.6, -18.5) | 2.1 (-7.5, 13.8) | | Cystoscopy | -0.4 (-9.8, 11.3) | 7.9 (-0.4, 17.7) | -4.3 (-11.2, 3.9) | -40.3a (-45.3, -34.4) | -40.0a (-44.0, -35.3) | -3.4 (-10.7, 5.2) | | Transperineal biopsy | 10.6 (-4.5, 31.4) | 6.8 (-6.9, 25.3) | 3.0 (-10.0, 20.2) | -13.4 (-26.6, 5.6) | -27.5a (-37.2, -14.1) | -11.6 (-25.1, 7.8) | | Non-Oncological procedures | | Stone surgeries | 2.2 (-10.8, 19.8) | -0.1 (-10.9, 13.7) | -8.2 (-17.3, 3.2) | -6.1 (-17.0, 8.0) | -32.9a (-39.4, -24.9) | -7.3 (-17.6, 6.0) | | Endoscopic procedures for benign prostatic hyperplasia | 2.7 (-8.5, 17.1) | 3.5 (-6.0, 15.1) | 3.4 (-5.8, 14.7) | -26.8a (-34.2, -17.5) | -42.4a (-46.9, -37.0) | -10.6a (-18.5, -1.0) |
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Percentage differences between observed and predicted number of urological procedures in Australia during the first wave of the COVID-19 pandemic.
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Diagnostic procedures in Australia between January 2017 and June 2020. (A) Observed diagnostic procedures between January 2017 and June 2020, modelled oncological diagnostic procedures between January 2017 and December 2019, and predicted (with 95% CI) diagnostic procedures between January 2020 and June 2020. (B) Observed and predicted (with 95% CI) diagnostic procedures between January 2020 and June 2020. CI, confidence interval.
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Non-oncological therapeutic procedures in Australia between January 2017 and June 2020. (A) Observed non-oncological therapeutic procedures between January 2017 and June 2020, modelled non-oncological therapeutic procedures between January 2017 and December 2019, and predicted (with 95% CI) non-oncological therapeutic procedures between January 2020 and June 2020. (B) Observed and predicted (with 95% CI) non-oncological therapeutic procedures between January 2020 and June 2020. CI, confidence interval.
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