Investigators who studied the effect of the COVID-19 pandemic on same-day discharge (SDD) of patients following robotic urologic surgery found no increase in 30-day complication and readmission rates compared with before the pandemic, according to a recent report.
“During crises like the COVID-19 pandemic, adopting a protocol of SDD after robotic surgery may allow more surgeries to be performed while preserving hospital beds and reducing postoperative patient exposure to infection and may allow for cost savings in the absence of such a crisis,” Ronney Abaza, MD, of OhioHealth Robotic Urologic and Cancer Surgery in Dublin, Ohio, and colleagues concluded in a paper published online in Urology.
The investigators conducted a single-institution study that compared 89 robotic urologic surgeries performed from March 17 to June 5, 2020 (defined as the COV period) with 1667 historical controls who had the same procedures performed prior to the pandemic (pre-COV group). Prostatectomies made up the vast majority of urologic surgeries (75.3% and 73.8% of the COV and pre-COV groups, respectively). Surgeries also included partial nephrectomies, partial cystectomies, and other procedures.
Dr Abaza’s team explained that they began routinely offering but not mandating SDD to patients undergoing robotic surgery beginning in 2016. The proportion of patients opting for SDD has increased since then without an increase in complications or readmissions “such that when the COVID-19 crisis began, we were comfortable increasing our efforts to achieve SDD in order to allow us to continue to surgically treat urologic cancer patients.”
Of the 1667 patients in the pre-COV group, 67 (4.0%) experienced a significant complication (Clavien-Dindo 3-5) within 30 days of surgery and 20 patients (1.2%) were readmitted for any cause within 30 days. The 30-day complication and readmission rates for the 861 patients (52%) who were discharged on the same day as surgery were 3.0% and 1.1%, respectively, demonstrating that SDD did not increase the risk of complications or readmissions.
The SDD rate rose to 98% during the COV period (87 of 89 patients), with the remaining 2 patients discharged on postoperative day 1. Two patients (2%) were readmitted within 30 days of surgery. There were no COVID-19 infections within 30 days.
The investigators also compared the COV and pre-COV groups with 42 patients who had robotic urologic surgery during the month following the COV period and found that the higher rate of SDD was maintained at 98%. No patient experienced significant complications.
“While the expected level of COVID infections in our state did not surge as much as expected, we still achieved nearly complete SDD after the need to preserve hospital beds had passed (post-COV),” the authors wrote. “Of course, this did rely on patient attitudes since we offered but did not force SDD, and it is possible that patient preferences will shift after the risk of nosocomial COVID-19 has passed with some no longer preferring the safety of home over an overnight stay.”
Abaza R, Kogan P, Martinez O. Impact of the COVID-19 crisis on same-day discharge after robotic urologic surgery. Published online January 19, 2021. Urology. doi:10.1016/j.urology.2021.01.012