Changes in Perioperative Outcomes after Robotic-Assisted Pulmonary Lobectomy during the COVID-19 Era

William N Doyle Jr; Diep Nguyen; William J West 3rd; Cole R Fiedler; Kristie M Labib; Lauren Ladehoff; Allison O Dumitriu Carcoana; Jenna C Marek; Jose A Malavet; Carla C Moodie; Joseph R Garrett; Jenna R Tew; Jobelle J A R Baldonado; Jacques P Fontaine; Eric M Toloza

doi:10.1016/j.sipas.2023.100172

Changes in Perioperative Outcomes after Robotic-Assisted Pulmonary Lobectomy during the COVID-19 Era

Surg Pract Sci. 2023 Jun:13:100172. doi: 10.1016/j.sipas.2023.100172. Epub 2023 Apr 25.

Authors

William N Doyle Jr¹, Diep Nguyen¹, William J West 3rd¹, Cole R Fiedler¹, Kristie M Labib¹, Lauren Ladehoff¹, Allison O Dumitriu Carcoana¹, Jenna C Marek¹, Jose A Malavet¹, Carla C Moodie², Joseph R Garrett², Jenna R Tew², Jobelle J A R Baldonado^{2

3

4}, Jacques P Fontaine^{2

3

4}, Eric M Toloza^{2

3

4}

Affiliations

¹ Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA.
² Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA.
³ Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA.
⁴ Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA.

Abstract

Background: The COVID-19 pandemic presented patients with barriers to receiving healthcare. We sought to determine whether changes in healthcare access and practice during the pandemic affected perioperative outcomes after robotic-assisted pulmonary lobectomy (RAPL).

Methods: We retrospectively analyzed 721 consecutive patients who underwent RAPL. With March 1^st, 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. Demographics, comorbidities, tumor characteristics, intraoperative complications, morbidity, and mortality were analyzed. Variables were compared utilizing Student's t-test, Wilcoxon rank-sum test, and Chi-square (or Fisher's exact) test, with significance at p $\leq 0.05 .$ Multivariable generalized linear regression was used to investigate predictors of postoperative complication.

Results: COVID-19-Era patients had significantly higher preoperative FEV1%, lower cumulative smoking history and higher incidences of preoperative atrial fibrillation, peripheral vascular disease (PVD), and bleeding disorders compared to PreCOVID-19 patients. COVID-19-Era patients had lower intraoperative estimated blood loss (EBL), reduced incidence of new-onset postoperative atrial fibrillation (POAF), but higher incidence of effusion or empyema postoperatively. Overall postoperative complication rates between the groups were similar. Older age, increased EBL, lower preoperative FEV1%, and preoperative COPD are all predictive of an increased risk for postoperative complication.

Conclusions: COVID-19-Era patients having lower EBL and less new-onset POAF, despite greater incidences of multiple preoperative comorbidities, demonstrates that RAPL is safe during the COVID-19 era. Risk factors for development of postoperative effusion should be determined to minimize risk of empyema in COVID-19-Era patients. Age, preoperative FEV1%, COPD, and EBL should all be considered when planning for complication risk.

Keywords: COVID-19; Lobectomy; Outcomes; Perioperative; Pulmonary; Robotic.