Effects of virtual postoperative postdischarge care in patients undergoing lung resection during the COVID-19 pandemic

Background: The COVID-19 pandemic has impacted the landscape of health care delivery, including a significant uptake in the use of virtual medicine. In our institution, this includes virtual visits for routine postoperative follow-up in patients undergoing major lung resections. The aim of this study was to evaluate the effects of COVID-19 on postoperative outcomes, and whether virtual follow-ups are associated with worse postoperative outcomes compared with in-person visits. Methods: A retrospective, single-centre propensity-matched cohort analysis was conducted. Patients undergoing anatomic lung resections were included. Outcomes of interest included 60-day readmission, emergency department (ED) visits, mortality, and complication rates. Initial analysis compared pre-COVID-19 (January-December 2019) patients to those receiving either inperson or virtual follow-up during the pandemic (March 2020February 2021). Secondary analysis compared COVID-19-era patients receiving mixed in-person/virtual follow-up (hybrid) to those receiving completely virtual care (no in-person visits). Results: In total, 1282 patients were assessed for eligibility. After propensity matching, 128 patients were included in the COVID-19-era group, and 212 patients in the pre-COVID-19 group. Baseline characteristics were similar in both groups. Initial analysis showed no statistically significant differences between COVID-19-era and pre-COVID-19 patients in terms of 60-day readmission (5.5% v. 7.5%, p = 0.57), ED visits (4.7% v. 6.6%, p = 0.77), mortality (0.8% v. 0.0%, p = 0.99), or complications. After subdividing patients with hybrid v. completely virtual follow-up, there was no significant difference in any outcome of interest (p > 0.05 for all). Conclusion: In our experience, early postoperative outcomes during the COVID-19 era were not inferior to those before COVID-19. Furthermore, evaluation of the impact of complete virtual follow-up for patients undergoing anatomic lung resection showed no significant differences in clinical outcomes compared with routine inperson follow up, suggesting that postoperative, postdischarge care might not be compromised by eliminating routine inperson assessments after major lung surgery.

Impact of the COVID-19 pandemic on non-small-cell lung cancer pathologic stage and presentation.

BACKGROUND: It is believed that the cessation of normative cancer care services during the COVID-19 pandemic may be resulting in pathologic upstaging and higher long-term mortality rates. We aimed to understand how the pandemic has affected our patients diagnosed with non-small-cell lung cancer (NSCLC). METHODS: We conducted a single-centre retrospective analysis to assess how the COVID-19 pandemic has affected patient referrals, pathologic stage of NSCLC, mortality rates and surgical procedures at our cancer care centre in Ontario, Canada. At our centre, physicians advocated for and followed recommendations that operations in cancer patients should be among the last procedures to be delayed. Patients were included if they were aged 18 years or older, were not receiving palliative care, and had been screened, diagnosed and treated for NSCLC (primary tumours). We compared outcomes between a prepandemic period (January 2019 to February 2020) and a period during the pandemic (March 2020 to February 2021). RESULTS: A total of 695 patients were included for statistical analysis, of whom 650 underwent surgery. There was no statistically significant difference in any of the outcomes of interest between patients seen before (n = 330) and during (n = 320) the pandemic. CONCLUSION: Cancer care services at our centre were maintained during the COVID-19 pandemic, and potential adverse effects on prognosis and survival that have been seen in other countries were avoided. The results inform health care providers how the effects of future pandemics can be blunted by using proactive preservative strategies and surgeon advocacy.

Smartphone Alcohol Use Disorder Recovery Apps: Cross-sectional Survey of Behavioral Intention to Use.

BACKGROUND: Alcohol use disorder (AUD) carries a huge health and economic cost to society. Effective interventions exist but numerous challenges limit their adoption, especially in a pandemic context. AUD recovery apps (AUDRA) have emerged as a potential complement to in-person interventions. They are easy to access and show promising results in terms of efficacy. However, they rely on individual adoption decisions and remain underused. OBJECTIVE: The aim of this survey study is to explore the beliefs that determine the intention to use AUDRA. METHODS: We conducted a cross-sectional survey study of people with AUD. We used the Unified Theory of Acceptance and Use of Technology, which predicts use and behavioral intention to use based on performance expectancy, effort expectancy, social influence, and facilitating conditions. Participants were recruited directly from 2 sources; first, respondents at addiction treatment facilities in Ontario, Canada, were contacted in person, and they filled a paper form; second, members from AUD recovery support groups on social media were contacted and invited to fill an internet-based survey. The survey was conducted between October 2019 and June 2020. RESULTS: The final sample comprised 159 participants (124 involved in the web-based survey and 35 in the paper-based survey) self-identifying somewhat or very much with AUD. Most participants (n=136, 85.5%) were aware of AUDRA and those participants scored higher on performance expectancy, effort expectancy, and social influence. Overall, the model explains 35.4% of the variance in the behavioral intention to use AUDRA and 11.1% of the variance in use. Social influence (P=.31), especially for women (P=.23), and effort expectancy (P=.25) were key antecedents of behavioral intention. Facilitating conditions were not significant overall but were moderated by age (P=.23), suggesting that it matters for older participants. Performance expectancy did not predict behavioral intention, which is unlike many other technologies but confirms other findings associated with mobile health (mHealth). Open-ended questions suggest that privacy concerns may significantly influence the use of AUDRA. CONCLUSIONS: This study suggests that unlike many other technologies, the adoption of AUDRA is not mainly determined by utilitarian factors such as performance expectancy. Rather, effort expectancy and social influence play a key role in determining the intention to use AUDRA.