As we conclude our second year of the COVID-19 era we reflect on our health care community’s ability to adapt to change and limited resources. Our ability to treat patients as we once did has changed as resources are limited, primarily hospital beds and staff. Inpatient surgical cases were delayed, however as a community we learned to adapt appropriately. Robot-assisted radical prostatectomy (RARP) is one surgery that was delayed during this time. This surgery generally involved a hospital stay of 24–48 hours. Same day surgery was implemented prior to the COVID-19 era with success in multiple institutions for RARPs and radical nephrectomies. Dr. Ronny Abaza has previously described incorporating a same day surgery program for robotic cases in urology. In 2016 their institution was completing 22% of robotic cases on an outpatient basis, which dramatically increased to 98% during the COVID-19 era. This was completed without an increase in readmissions or emergency department visits. Patient and family education is key in the preoperative and postoperative period. Providing printed educational material and early catheter care can help avoid readmissions and phone calls after discharge.¹

Our recent experience with same day discharge for RARP at Mayo Clinic Arizona, which was incorporated into practice prior to the start of the pandemic, was presented at the AUA annual meeting by Dr. Faraj. A retrospective review was completed between June 2019 and July 2020 of 283 RARPs completed at our institution. Same day discharge was successful in 29 (34.9%) patients during the COVID-19 era and 13 (6.5%) patients prior to the COVID-19 era. Preoperatively, all patients meet with a urology nurse to obtain education on drain care, Foley catheter management, narcotic use and expected recovery. These were made virtual with larger groups at the start of the pandemic. After surgery, patients are expected to ambulate, tolerate a diet and have appropriate pain control prior to discharge. When comparing patients who were discharged and admitted after surgery there were no statistical differences in complications rates. Additionally, there were no significant differences in readmission rates, emergency department visits or followup phone calls between the groups.² Our institution, along with many others, implemented same day surgery for RARPs and radical nephrectomies in a relatively short time period with good success.

As a health care system we adopted additional precautions which included prioritizing high-risk patients and incorporating telemedicine when appropriate. Our ability to adapt and strive as a health care community was challenged during the COVID-19 era and these studies demonstrate our capability to do so with great success. Shifting cases that previously required a 24- to 48-hour admission to outpatient has significantly impacted health care costs. In a study presented by Dr. Abaza in 2019, there was a saving of $345,876 per year when completing same day surgery for RARPs.³ Our health care community continues to adapt and learn during the pandemic, and with continued technological advancements in urology we continue to improve patient care and outcomes.