Robotic HPB surgery and impact of COVID-19 in a community hospital setting

Siddiqui, I.

Presenter: Imran Siddiqui MD ;Hartford Healthcare St.Vincent's Medical Center Background: Complex hepatopancreaticobiliary (HPB) surgery is associated with high morbidity even in high volume tertiary care centers. Minimally invasive robotic HPB surgeries including robotic whipple and major hepatectomies are resource intense. The COVID-19 pandemic has brought about new challenges in terms of resources and patient safety. We evaluate outcomes of patients undergoing Robotic HPB oncology surgery at high volume community center during COVID-19 pandemic Methods: All patients undergoing robotic HPB and foregut surgery for malignancies from March 2020 to January 2021 were included. Non-malignant indications were excluded. Mortality, morbidity, length of stay and oncologic outcomes were evaluated. Nosocomial COVID-19 infection and mortality and morbidity associated with it were evaluated separately Results: 33 patients were included out of which 22 of which were robotic and others included laparoscopy and hybrid approaches Surgeries included robotic whipple, robotic major hepatectomies, robotic gastrectomies, robotic duodenal resection, robotic biliary and gastric bypass surgery. Clavien III/IV morbidity was 6.5%. There was no post-operative respiratory failure or 30-day mortality. No patients were diagnosed with COVID 19 in the postoperative setting and none developed symptoms in the 30-day post-operative period. All patients were cared for in dedicated non COVID units and were discharged home or COVID free rehab centers. All patients who needed adjuvant treatment received it in a timely setting. Conclusion: Although COVID-19 pandemic has had a significant impact on the mortality and morbidity in the general setting and data has demonstrated worse outcomes for patients with COVID-19 in the post-operative period, we describe in this case series that with COVID safety protocols and preoperative testing, even complex and resource intense surgeries like robotic HPB surgeries can be performed safely in a community hospital setting with significant resource limitations.