ABSTRACT
INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has impacted the ability to treat patients with prostate cancer due to increases in COVID-19 related hospital admissions and limited hospital bed availability. Same-day discharge (SDD) has previously been established as safe in patients who undergo robot assisted radical prostatectomy (RARP). We present our experience in implementing a SDD protocol using enhanced recovery after surgery (ERAS) principles. METHODS: This is a retrospective review that included all patients who underwent RARP at our institution between 06/01/2019 and 07/01/2020. Patient were stratified into two cohorts based on when COVID-19 restrictions were implemented at our institution: Pre COVID- 19 era (06/01/2019-02/29/2020) and COVID-19 era (03/01/2020-07/01/ 2020). During the COVID-19 era, we implemented a protocol that supported SDD by minimizing opioid use, encouraging ambulation immediately after surgery, and early oral intake. Success of SDD was assessed and perioperative complications were compared between the cohorts. RESULTS: In 283 prostatectomies performed at our institution during this review, 83 (29.3%) were performed during the COVID-19 era. The pre COVID-19 era contained more patients who had cT1 disease (56.0% vs 20.5%) and less patients with >cT3 (10.5% vs 30.1%, p<0.001). Same-day discharge was successfull in 29 (34.9%) of patients in the COVID-19 era vs 13 (6.5%) in the pre COVID-19 era (p<0.001). In the most recent 3 months at our institution, SDD rates have continued to increase to 67.4%, with 100% success in the most recent month. Overall complication rates, including hospital readmission, emergency department visits, and telephone calls after surgery did not differ between cohorts (p>0.05). CONCLUSIONS: We present practice changes that permitted the surgical management of prostate cancer patients to continue in an era where hospital bed capacity is limited by using ERAS protocols to rapidly and safely increase the SDD rate after surgery. Implications of such changes can be significant on the institutional and healthcare system level.