Changes in Perioperative Outcomes after Robotic-Assisted Pulmonary Lobectomy during the COVID-19 Era

William N. Doyle, Jr; Diep Nguyen; William J. West, III; Cole R. Fiedler; Kristie M. Labib; Lauren Ladehoff; Allison O. Dumitriu Carcoana; Jenna C. Marek; Jose A. Malavet; Carla C. Moodie; Joseph R. Garrett; Jenna R. Tew; Jobelle J.A.R. Baldonado; Jacques P. Fontaine; Eric M. Toloza

Surgery in Practice and Science (Jun 2023)

Changes in Perioperative Outcomes after Robotic-Assisted Pulmonary Lobectomy during the COVID-19 Era

William N. Doyle, Jr,
Diep Nguyen,
William J. West, III,
Cole R. Fiedler,
Kristie M. Labib,
Lauren Ladehoff,
Allison O. Dumitriu Carcoana,
Jenna C. Marek,
Jose A. Malavet,
Carla C. Moodie,
Joseph R. Garrett,
Jenna R. Tew,
Jobelle J.A.R. Baldonado,
Jacques P. Fontaine,
Eric M. Toloza

Affiliations

William N. Doyle, Jr: Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
Diep Nguyen: Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
William J. West, III: Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
Cole R. Fiedler: Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
Kristie M. Labib: Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
Lauren Ladehoff: Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
Allison O. Dumitriu Carcoana: Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
Jenna C. Marek: Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
Jose A. Malavet: Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
Carla C. Moodie: Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
Joseph R. Garrett: Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
Jenna R. Tew: Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
Jobelle J.A.R. Baldonado: Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA; Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA; Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
Jacques P. Fontaine: Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA; Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA; Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
Eric M. Toloza: Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA; Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA; Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA; Address Correspondence to: Eric M. Toloza, 12902 USF Magnolia Drive, Suite CSB-6 (ThorProg), Tampa, FL 33612 USA, Telephone: 813-745-7282

Journal volume & issue: Vol. 13
p. 100172

Abstract

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Background: The COVID-19 pandemic presented patients with barriers to receiving healthcare. We sought to determine whether changes in healthcare access and practice during the pandemic affected perioperative outcomes after robotic-assisted pulmonary lobectomy (RAPL). Methods: We retrospectively analyzed 721 consecutive patients who underwent RAPL. With March 1st, 2020, defining the start of the COVID-19 pandemic, we grouped 638 patients as “PreCOVID-19” and 83 patients as “COVID-19-Era” based on surgical date. Demographics, comorbidities, tumor characteristics, intraoperative complications, morbidity, and 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. Multivariable generalized linear regression was used to investigate predictors of postoperative complication. Results: COVID-19-Era patients had significantly higher preoperative FEV1%, lower cumulative smoking history and higher incidences of preoperative atrial fibrillation, peripheral vascular disease (PVD), and bleeding disorders compared to PreCOVID-19 patients. COVID-19-Era patients had lower intraoperative estimated blood loss (EBL), reduced incidence of new-onset postoperative atrial fibrillation (POAF), but higher incidence of effusion or empyema postoperatively. Overall postoperative complication rates between the groups were similar. Older age, increased EBL, lower preoperative FEV1%, and preoperative COPD are all predictive of an increased risk for postoperative complication. Conclusions: COVID-19-Era patients having lower EBL and less new-onset POAF, despite greater incidences of multiple preoperative comorbidities, demonstrates that RAPL is safe during the COVID-19 era. Risk factors for development of postoperative effusion should be determined to minimize risk of empyema in COVID-19-Era patients. Age, preoperative FEV1%, COPD, and EBL should all be considered when planning for complication risk.

Published in Surgery in Practice and Science

ISSN: 2666-2620 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Surgery
Website: https://www.journals.elsevier.com/surgery-in-practice-and-science/

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