OBJECTIVES: During the COVID-19 pandemic, hospitals were encouraged to pause elective surgeries for benign indications, prioritize non-surgical cancer treatments, and minimize hospital stays among oncology patients still undergoing surgeries. However, no specific recommendations were provided about triaging procedures by surgical modality. We aim to identify changes during the pandemic in surgical volume and post-operative length of stay (LOS) among procedures for malignant indications and if there were differences across surgical modalities.

METHODS: The study identified adult patients who had an elective colectomy with a malignant indication in 2019 or 2020 in the Premier Healthcare Database®. Among hospitals contributing data in both years, we compared quarterly year-over-year changes in colectomy volumes and LOS from 2019 to 2020 and stratified by modality, including open, laparoscopic, and robotic assisted surgery (RAS). We also conducted a difference-in-difference analysis using Poisson regression to test changes in volumes by modality and a multiple linear regression to identify trends in LOS among inpatients, controlling for patient and clinical characteristics.

RESULTS: In 725 hospitals, malignant procedure volumes declined from 50,369 in 2019 to 42,510 in 2020 and mean LOS fell by 0.2 days. Procedure volumes varied significantly by surgical modality. Beginning in Q3, 2020 volumes for RAS surgieries returned closer to 2019 baseline values whereas open and laparoscopic volumes did not. In 2020, LOS was significantly shorter among RAS procedures (2.9 days) compared to lapraoscopic (4.5 days, p<0.001) and open (5.2, p<0.001). While average LOS decreased during in 2020 relative to 2019 in all modalities, these improvements were largest in RAS patients.

CONCLUSION: Declines in malignant colectomy volumes were observed in 2020 compared to the corresponding quarters of 2019. RAS surgeries returned to 2019 baseline volumes in the second half of 2020, relative to laparoscopic and open surgeries. Post-operative LOS declined and remained lowest among RAS surgical modalities.