Introduction:

Robot-assisted laparoscopic prostatectomy (RALP) and Transurethral Resection of Bladder Tumor (TURBT) are two common surgical treatments for prostate and bladder cancer. While TURBT is routinely performed in ambulatory setting, recent years have seen a shift towards “outpatient” RALP. The outbreak of COVID resulted in limited hospital bed space. We hypothesized that this would hasten the shift towards ambulatory RALP.  To assess whether this occurred, we compared ambulatory TURBT and RALP before and during COVID pandemic using a large state administrative database.

Methods:

We identified all adults who underwent RALP and TURBT within the State Inpatient Database and the State Ambulatory Surgery Database in California between 2018 and 2020. Our primary outcome was the proportion of index procedures performed in ambulatory settings. Ambulatory surgeries were identified as index procedures recorded in State Ambulatory Surgery Database with length of stay of zero day. Univariable and Multivariable analyses were performed to investigate the clinical and demographic factors associated with ambulatory utilization prior to and during the first waves of COVID pandemic. Spline regression with a knot at the pandemic outbreak was performed to compare the rate of the change ambulatory RALP and TURBT pre- and post- pandemic.

Results:

There were 17386 men who underwent RALP, of them 6774 (39.0%) were performed in ambulatory settings. There were 25148 patients who underwent TURBT, of them 21573 (85.8%) were performed in an ambulatory setting. 33.5% vs. 53.8% of RALP (p<0.001) and 85.2% vs. 87.9% of TURBT (p<0.001) were ambulatory before and after the first wave of COVID. In multivariable model, RALP and TURBT performed after the first wave of COVID in March 2020 were 2.31 and 1.25 times more likely to be ambulatory (OR=2.31, 95% CI: 1.76-3.04; OR=1.25, 95% CI: 1.14-1.38). Spline curve analysis indicated an overall rising trend of ambulatory utilization of RALP in both the pre- and post-pandemic eras. There was no significant change of trend at the time of first COVID peak (p = 0.642). TURBT exhibited an increased shift towards ambulatory utilization after the initial surge of COVID (p<0.0001).

Conclusion:

Our analysis revealed an increase in the proportion of ambulatory RALP and TURBT following the first wave of COVID. In the case of TURBT, both adjusted and unadjusted proportion of ambulatory surgery as well as the time trend of the likelihood of ambulatory TURBT was significantly higher post-COVID. In RALP, there was a large and statistically significant increase in the proportion of ambulatory surgeries. The time trend of ambulatory RALP was increasing throughout our study period and was not significantly different pre- and post-COVID—possibly due to a pre-existing trend towards ambulatory RALP which pre-dated the start of the pandemic.  

Funding: N/A