MP74-18: Impact of surgical wait times during summer months on the oncological outcomes following robotic-assisted radical prostatectomy: 10 years' experience from a large Canadian Academic Center

Ahmed Sayed Zakaria, Félix Couture, David-Dan Nguyen, Hanna Shahine, Côme Tholomier, Cristina Negrean, Kyle Law, Pierre Karakiewicz Karakiewicz, Assaad El-Hakim, Kevin Zorn

Introduction: Most Canadian hospitals face significant reductions (20-50%) in operative room access during summer months due to nursing shortages, leading to increased surgical delays. Hence, we sought to assess the impact of this extra-wait time to undergo robotic-assisted radical prostatectomy (RARP) on the post-operative oncological outcomes

Methods: We conducted a retrospective review of a prospectively maintained RARP database in two high-volume academic centers, between 2010 and 2019. Wait time was defined as the interval between surgical booking and RARP. Assessed outcomes included impact on the difference between post-biopsy USCF-CAPRA and post-surgical CAPRA-S scores, biochemical recurrence (BCR) rates and Gleason score upgrade on surgical specimen. Multivariable analysis (MVA) with regression models was used to evaluate the effect of wait times

Results: A total of 1057 men were included for analysis. Consistent over a 10-year period, analysis of mean surgical/operative booking volumes (Fig.1-A), revealed that summer months had the lowest surgical volumes output despite above average booking volumes. The lowest surgical volume occurred during July (7.1case/month), which was 35% less than the cohort average. Moreover, summer months had the longest average time between surgical booking date and RARP, with the longest wait occurring for patients booked in June (average 93±69 days, p<0.001). On MVA, patients booked in June had significantly more chance of having an increase in CAPRA score [HR (95%CI) 1.64 (1.02-2.63); p=0.04] and in CAPRA risk group [HR (95%CI) 1.82 (1.04-3.19)] after surgery compared to patients booked in other months. Cohort analysis (Fig.1-B) showed fair correlation between CAPRA-score difference and time between booking and RARP (r=-0.062; p=0.044)

Conclusions: Our cohort results demonstrate that conventional RARP wait times are significantly prolonged during summer months, with worse post-RARP oncological outcomes in terms of CAPRA score, which is associated with a higher risk of BCR. Further national studies are required to address these delays in other oncological populations. Moreover, other compensatory mechanisms to sustain consistent yearly operative output should be considered Source of

Funding: None