Changes in Urologic Cancer Surgical Volume and Length of Stay During the COVID-19 Pandemic in Pennsylvania

Abstract

ImportanceDisruptions in cancer surgery during the COVID-19 pandemic led to widespread deferrals and cancellations, creating a surgical backlog that presents a challenge for health care institutions moving into the recovery phase of the pandemic.ObjectiveTo describe patterns in surgical volume and postoperative length of stay for major urologic cancer surgery during the COVID-19 pandemic.Design, Setting, and ParticipantsThis cohort study identified 24 001 patients 18 years or older from the Pennsylvania Health Care Cost Containment Council database with kidney cancer, prostate cancer, or bladder cancer who received a radical nephrectomy, partial nephrectomy, radical prostatectomy, or radical cystectomy between the first quarter (Q1) of 2016 and Q2 of 2021. Postoperative length of stay and adjusted surgical volumes were compared before and during the COVID-19 pandemic.Main Outcomes and MeasuresThe primary outcome was adjusted surgical volume for radical and partial nephrectomy, radical prostatectomy, and radical cystectomy during the COVID-19 pandemic. The secondary outcome was postoperative length of stay.ResultsA total of 24 001 patients (mean [SD] age, 63.1 [9.4] years; 3522 women [15%], 19 845 White patients [83%], 17 896 living in urban areas [75%]) received major urologic cancer surgery between Q1 of 2016 and Q2 of 2021. Of these, 4896 radical nephrectomy, 3508 partial nephrectomy, 13 327 radical prostatectomy, and 2270 radical cystectomy surgical procedures were performed. There were no statistically significant differences in patient age, sex, race, ethnicity, insurance status, urban or rural status, or Elixhauser Comorbidity Index scores between patients who received surgery before and patients who received surgery during the pandemic. For partial nephrectomy, a baseline of 168 surgeries per quarter decreased to 137 surgeries per quarter in Q2 and Q3 of 2020. For radical prostatectomy, a baseline of 644 surgeries per quarter decreased to 527 surgeries per quarter in Q2 and Q3 of 2020. However, the likelihood of receiving radical nephrectomy (odds ratio [OR], 1.00; 95% CI, 0.78-1.28), partial nephrectomy (OR, 0.99; 95% CI, 0.77-1.27), radical prostatectomy (OR, 0.85; 95% CI, 0.22-3.22), or radical cystectomy (OR, 0.69; 95% CI, 0.31-1.53) was unchanged. Length of stay for partial nephrectomy decreased from baseline by a mean of 0.7 days (95% CI, −1.2 to −0.2 days) during the pandemic.Conclusions and RelevanceThis cohort study suggests that partial nephrectomy and radical prostatectomy surgical volume decreased during the peak waves of COVID-19, as did postoperative length of stay for partial nephrectomy.

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“…This study showed a reduced LOS during the COVID-19 pandemic. This aligns with findings from multiple studies across different types of surgery which reported a similar reduction in LOH during the pandemic, including adult spinal deformity surgery [ 40 ], elective colorectal surgery [ 41 , 42 ], brain tumor surgery [ 43 ], bariatric surgery [ 44 ], and partial nephrectomy [ 45 ] without compromising surgical outcomes. Several factors may have contributed to this decrease.…”

“…The pandemic increased the demand for hospital beds and shortening the hospital stay was a strategy to maintain the volume of surgery [ 44 ]. Patients may have also wanted to limit their hospital stays to reduce the risk of exposure to COVID-19 [ 40 , 45 ]. Moreover, patients were also more willing to follow hospitals’ recommendations than before the COVID-19 pandemic [ 40 , 46 ].…”