ABSTRACT
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.
ABSTRACT
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.