ABSTRACT
INTRODUCTION: The COVID-19 pandemic has presented patients with barriers to receiving healthcare. We sought to determine whether changes in healthcare access and practice during the COVID-19 pandemic has affected perioperative outcomes after robotic-assisted pulmonary lobectomy (RAPL). METHOD(S): We retrospectively analyzed 721 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 638 patients as PreCOVID-19 and 83 patients as COVID-19-Era based on surgical date. An optimal variable ratio matching method of one to four PreCOVID-19 patients (with average of three) were matched to each COVID-19-Era patient. Variables used for matching were age, gender, smoking history in pack-years, and preoperative diabetes mellitus, coronary artery disease or myocardial infarction, and FEV1%. Variables of interest 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 the presence of postoperative complications and report odds ratios (OR). RESULT(S): COVID-19-Era patients had higher incidences of preoperative atrial fibrillation (p=0.027), peripheral vascular disease (p=0.0425), and pancreatitis (p=0.0349) compared to PreCOVID-19 patients. Differences in tumor size and histology, nodal status, and AJCC v8 pathologic stage were statistically insignificant. COVID-19-Era patients experienced a high incidence of effusion or empyema postoperatively (p< 0.0001). The PreCOVID-19 and COVID-19-Era cohorts had comparable odds for developing a postoperative complication. Older age, longer intraoperative skin-to-skin duration, and preoperative COPD are all predictive of an increased risk of developing a postoperative complication (Table 1). CONCLUSION(S): Despite our COVID-19-Era patients having greater indices of preoperative comorbidities, our analysis showed that they had a similar risk of developing a postoperative complication when compared to our PreCOVID-19 patients. Risk factors for development of postoperative effusion should be determined to minimize risk of empyema in COVID-19-Era patients. Patient age, skin-to-skin duration of the procedure, and preoperative COPD should be considered when planning for complication risk following RAPL.