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Impact of the COVID-19 Pandemic on Perioperative Outcomes after Robotic-Assisted Pulmonary Lobectomy
William N. Doyle, Jr1, Diep Nguyen1, Jenna Marek1, Jose Malavet1, Allison Dumitriu-Carcoana1, Rahul Mhaskar1, Joseph R. Garrett2, Carla C. Moodie2, Jenna R. Tew2, Jobelle J.J.A.R. Baldonado2, Jacques P. Fontaine2, Eric M. Toloza2.
1University of South Florida Health Morsani College of Medicine, Tampa, FL, USA, 2Moffitt Cancer Center, Tampa, FL, USA.

OBJECTIVE: The COVID-19 pandemic presented patients with barriers to receiving healthcare. We sought to determine whether changes in healthcare access and practice during the COVID-19 pandemic affected perioperative outcomes after robotic-assisted pulmonary lobectomy (RAPL).
METHODS: We retrospectively analyzed 720 consecutive patients who underwent RAPL between September 2010 and March 2022 by one surgeon at one institution. With March 1st, 2020, defining the start of the COVID-19 pandemic, we grouped 639 patients as “PreCOVID-19” and 81 patients as “COVID-19-Era” based on surgical date. Demographics, preoperative comorbidities, intraoperative and postoperative complications, tumor size and histology, nodal status, AJCC v8 pathologic stage, chest tube duration, hospital length of stay, and 30-day mortality were analyzed. Variables were compared utilizing Student’s t-test, Wilcoxon rank-sum test, and Chi-square (or Fisher’s exact) test, with significance at p<0.05.
RESULTS: COVID-19-Era patients had higher preoperative FEV1% (p=0.0036) and higher incidences of preoperative atrial fibrillation (p=0.0300), peripheral vascular disease (PVD; p=0.0023), and bleeding disorders (p=0.0333) compared to PreCOVID-19 patients (Table 1). COVID-19-Era patients had lower intraoperative estimated blood loss (EBL; p<0.0001) and reduced incidence of new-onset postoperative atrial fibrillation (POAF; p=0.0258) but had higher incidence of effusion or empyema (p<0.0001) postoperatively (Table 1).
CONCLUSIONS: Our COVID-19-Era patients having lower EBL and less new-onset POAF, despite greater incidences of preoperative atrial fibrillation, PVD, and bleeding disorders, demonstrates that RAPL is feasible and safe even during the COVID-19 era. Risk factors for development of postoperative effusion, such as capillary leak, should be determined to minimize risk of empyema in COVID-19-Era patients.


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