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
Background: Social media platforms such as Twitter are highly utilized to communicate about cancer care. Although surgery is the primary treatment for solid malignancies, little is known about public perceptions or communication behaviors regarding this treatment modality. Further, prolonged lockdowns and widespread delays of planned operations during the COVID-19 pandemic have magnified the importance of virtual communication about surgical cancer care. Methods: Tweets referencing cancer surgery were collected from January 2018 to January 2022 using Twitter's Application Programming Interface. Account metadata was used to predict user demographic information and to compare tweeting metrics across users. Natural language processing models were applied to tweet content to resolve common topics of conversation and to classify tweets by cancer type. Results: There were 442,840 original tweets about cancer surgery by 262,168 users. Individuals accounted for most users (65%) while influencers accounted for the least (1.4%). Influencers made the most median impressions (19,139). Of 240,713 tweets discussing surgery for specific cancers, breast (20%) and neurologic (17%) cancers were most mentioned. When adjusting for national rates of procedures performed, tweets about surgery for neurologic cancers were the most common (231 tweets per 1000 procedures) whereas those for urologic cancers were the least common (15 tweets per 1000 procedures). Discussions about cancer surgery research made up 31% of tweets before the pandemic but only 11% of tweets during the pandemic. During the pandemic, concern regarding COVID-19 related delays was the most tweeted topic (23%). Cancer surgery research was most cited by oncologists, as well as in tweets about hepatopancreatobiliary and colorectal cancers. The cost of surgery was commonly mentioned in tweets about breast and gynecologic cancers and contained the most negative sentiment score (-0.7). Conclusions: Twitter was highly utilized to discuss surgical cancer care during the COVID- 19 pandemic. During the pandemic, conversations shifted focus from research to survivorship and reflected real-time events such as COVID-19-related surgical delays. We identified the financial burden of cancer care as a commonly held concern among patients discussing cancer surgery on social media. Future public health outreach about cancer surgery may be optimized by coordinating with influencers and by targeting topics of concern like cost of surgery and undermentioned content like urologic cancers. Twitter's role as a platform for research dissemination was disrupted by the COVID-19 pandemic, and further tracking is needed regarding online research discussions after the pandemic.