Comparative assessment of pre- and post-COVID-19 pandemic nephrectomy outcomes for renal cell carcinoma: Analysis of the ACS-NSQIP registry.

Abstract

466 Background: The COVID-19 pandemic placed significant strain on healthcare systems in the U.S. Public health directives aimed at mitigating the spread of new COVID-19 cases, such as regional stay-at-home orders, resulted in the cancellation or significant delay of many surgical cases. This study aimed to examine the impact of COVID-19 on surgical outcomes after elective nephrectomy in patients with renal cell carcinoma (RCC). Methods: The ACS NSQIP database for 2019 through 2021 was queried for adult patients with RCC undergoing partial nephrectomy (CPT codes 50240, 50543) or radical nephrectomy (CPT codes 50220, 50225, 50230, 50545, 50546). Patients were stratified into pre-pandemic (2019 Q1-Q4, 2020 Q1) and post-pandemic (2020 Q2-Q4, 2021 Q1-Q4) cohorts. Outcomes included total operation time, length of total hospital stay, unplanned reoperation, hospital readmission, prolonged stay in the hospital, urologic-specific complications (superficial incisional SSI, deep incisional SSI, organ/space SSI, wound disruption, acute renal failure, urinary tract infections), systemic complications (pneumonia, unplanned intubation, on ventilator for greater than 48 hours, stroke/CVA, cardiac arrest requiring CPR, myocardial infarction, bleeding transfusion, DVT/thrombophlebitis, sepsis, sepsis shock), and 30-day mortality. Results: A total of 19,102 patients met inclusion criteria, with 8,321 patients in the pre-pandemic cohort and 10,781 in the post-pandemic cohort. On univariate analysis, the post-pandemic cohort had longer operative times ( p <0.001), shorter length of total hospital stay (p<0.001), and a higher proportion of outpatient procedures ( p <0.001). The post-pandemic cohort also had a higher proportion of patients with an ASA Physical Status Classification of III or above ( p =0.003), diabetes mellitus ( p = 0.006), or CHF in the 30 days prior to surgery ( p <0.001). Multivariate analysis of 30-day complications and adverse outcomes revealed no significant difference between the two cohorts, except that patients who underwent partial nephrectomy in the pre-pandemic cohort experienced septic shock significantly more often than patients in the post-pandemic cohort (OR=4.19, 95% CI: 1.17-15.00, p =0.028). Conclusions: While the onset of the COVID-19 pandemic was associated with longer operative times, shorter hospital stays, and a higher proportion of outpatient procedures, there is no evidence that the pandemic worsened 30-day surgical outcomes after nephrectomy in patients with RCC. Multivariate adjusted analysis of 30-day complications and adverse events associated with radical and partial nephrectomy (reference group set as the post-pandemic cohort). Radical Nephrectomy Partial Nephrectomy OR [95% CI] P Value OR [95% CI] P Value Any complication 0.93[0.82-1.04] 0.201 1.01[0.88-1.17] 0.894 Death 0.97[0.58-1.67] 0.898 0.68[0.27-1.72] 0.420 Hospital readmission 0.86[0.71-1.04] 0.115 0.93[0.77-1.13] 0.480 Unplanned reoperation 0.83[0.61-1.13] 0.230 0.96[0.71-1.30] 0.773 Still in hospital > 30 days 1.07[0.45-2.54] 0.881 2.21[0.45-10.97] 0.332