ABSTRACT
INTRODUCTION AND OBJECTIVE: Radical prostatectomy lengths of stay decreased with ketorolac analgesia and adoption of robotic assisted radical prostatectomy (RARP). During the COVID-19 pandemic, the transition to outpatient RARP freed up critically needed hospital beds. The healthcare cost reduction afforded by the shift to outpatient RARP and its effect on patient satisfaction has yet to be explored. We compared healthcare costs, patient satisfaction and complications for outpatient vs. inpatient RARP. METHOD(S): We identified and compared a series of consecutive RARP performed as outpatient vs. inpatient and determined the capacity cost rate for every resource, including personnel, equipment, and space. After the lifting of hospital restrictions, men were given the option of inpatient vs. outpatient RARP. We also administered a validated Patient Satisfaction Outcome Questionnaire (PSOQ) postoperatively and compared median scores in perceived outcomes and satisfaction. A time-driven activity-based costing (TDABC) analysis was applied to compare the total costs of care for RARP performed. Finally, we captured complications within 30 days of surgery using the Clavien-Dindo classification. We used multivariable regression to adjust for age, race, BMI, and ASA classification to assess the impact of outpatient vs. inpatient RARP on complications. RESULT(S): There were no significant differences in patient characteristics for outpatient (n=145) vs. inpatient (n=80) RARP. When given the choice, 86.6% of men elected for outpatient vs. inpatient RARP. Outpatient RARP netted a $1387 (13.5%) cost reduction compared to inpatient RARP. There were no significant differences in outpatient vs. inpatient median satisfaction survey scores or complications within 30 days (11.0% vs. 11.3%, p=0.961). CONCLUSION(S): Outpatient RARP can be safely performed, with similar outcomes and compared to inpatient RARP. Outpatient RARP has significantly lower costs compared to inpatient RARP while maintaining similar patient satisfaction outcomes.
ABSTRACT
INTRODUCTION AND OBJECTIVE: While subject to frequent speculation, the actual impact of the COVID-19 pandemic on urologic operative practice is unknown. Understanding the consequences of the pandemic will teach invaluable lessons for future preparedness and provide useful context for individual practices attempting to understand changes in operative volume. We analyzed populationlevel changes in operative practice since the onset of the COVID-19 pandemic to contextualize observations made by individual practices and optimize future responses. METHODS: We used Premier Perspectives Database to investigate changes in operative volume through March 2020. Baseline operative volume for urologic surgery was calculated using data from the preceding 12 months and compared on a total and by procedure basis. Multivariable linear regression was used to identify hospital-level predictors of change in response to the pandemic. Our primary outcome of interest was the change in operative volume in March 2020 relative to baseline. Total operative volume, and volume by procedure and procedure-based groupings were investigated. RESULTS: At baseline, we captured 23,788 urologic procedural encounters per month as compared with 19,071 during March 2020e a 19.9% decrease. Urologic oncology-related cases were relatively preserved as compared to others (average change in March 2020: =1.1% versus -32.2%). Northeastern (b=-5.66, 95% confidence interval [CI]: -10.2 to -1.18, p=.013) and Midwestern hospitals (b=-4.17, 95% CI: -7.89 to -0.45, p=.027;both with South as reference region), and those with an increasing percentage of patients insured by Medicaid (b= -.17 per percentage point, 95% CI: -.33 to -.01, p=.04) experienced a significantly larger decrease in volume. CONCLUSIONS: There was a 20% decline in urologic operative volume in March 2020, compared with baseline, that preferentially affected hospitals serving Medicaid patients, and those in the Northeast and Midwest. In the face of varying mandates on elective surgery, widespread declines in operative volume may also represent hesitancy on behalf of patients to interface with healthcare during the pandemic. Long-term follow-up will be necessary to determine COVID-19's final toll on urology.