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: The COVID-19 pandemic led to substantial shifts in pediatric diabetes care delivery to virtual and hybrid models. It is unclear if these changes in care delivery impacted short-term patient outcomes. Objectives: We aimed to explore glycemic control and other diabetes-related outcomes in children living with Type 1 Diabetes Mellitus (T1DM) during the first year of the COVID-19 pandemic at a tertiary pediatric academic center in Canada. Subjects: Patients <18 years of age with a confirmed diagnosis of T1DM for at least one year were included. Methods: This was a retrospective chart review. We compared data from two years pre-pandemic (March 15, 2018-March 14, 2020) to the first year of the pandemic (March 15, 2020-March 14, 2021). The data assessed included glycemic control [Hemoglobin A1c (HbA1c)], diabetic ketoacidosis (DKA), hospital attendance and hospitalizations, hypoglycemia, and hyperglycemia. The generalized estimating equation (GEE) analysis was used to model potential factors affecting the HbA1c and diabetes-related morbidities. Multiple imputations were conducted as a sensitivity analysis. Results: There were 346 eligible patients included in the study. The HbA1c remained stable during the pandemic compared to the pre-pandemic phase (MD-0.14, 95% CI, -0.28, 0.01; p = 0.058). The pandemic saw an increase in the number of newly diagnosed patients (X2 = 16.52, p < 0.001) and a higher number of newly diagnosed patients presenting in DKA (X2 = 12.94, p < 0.001). In patients with established diabetes, there was an increase in hyperglycemia (OR1.38, 95% CI, 1.12,1.71; p = 0.003) and reduced DKA (OR 0.30, 95% CI, 0.12,0.73; p = 0.009) during the pandemic compared to the pre-pandemic phase. Stable rates of hospitalization (OR0.57, 95% CI, 0.31,1.04, p = 0.068) and hypoglycemia (OR1.11, 95% CI, 0.83,1.49; p = 0.484) were noted. These results were retained in the sensitivity analysis. Conclusions: Glycemic control in children with T1DM remained stable during the first year of the pandemic. There were more newly diagnosed patients during the pandemic compared to the pre-pandemic phase, and more of these new patients presented in DKA. The latter presentation was reduced in those with established diabetes during the same period.Further studies are needed to assess the ongoing impact of the COVID-19 pandemic on T1DM care pathways and outcomes to allow children, families, and diabetes teams to personalize choices of care models.
ABSTRACT
Background The COVID-19 pandemic led to substantial shifts in pediatric diabetes care delivery to virtual and hybrid models. It is unclear if these changes in care delivery impacted short-term patient outcomes. Objectives We aimed to explore glycemic control and other diabetes-related outcomes in children living with Type 1 Diabetes Mellitus (T1DM) during the first year of the COVID-19 pandemic at a tertiary pediatric academic center in Canada. Subjects Patients <18 years of age with a confirmed diagnosis of T1DM for at least one year were included. Methods This was a retrospective chart review. We compared data from two years pre-pandemic (March 15, 2018–March 14, 2020) to the first year of the pandemic (March 15, 2020–March 14, 2021). The data assessed included glycemic control [Hemoglobin A1c (HbA1c)], diabetic ketoacidosis (DKA), hospital attendance and hospitalizations, hypoglycemia, and hyperglycemia. The generalized estimating equation (GEE) analysis was used to model potential factors affecting the HbA1c and diabetes-related morbidities. Multiple imputations were conducted as a sensitivity analysis. Results There were 346 eligible patients included in the study. The HbA1c remained stable during the pandemic compared to the pre-pandemic phase (MD-0.14, 95% CI, −0.28, 0.01;p = 0.058). The pandemic saw an increase in the number of newly diagnosed patients (X2 = 16.52, p < 0.001) and a higher number of newly diagnosed patients presenting in DKA (X2 = 12.94, p < 0.001). In patients with established diabetes, there was an increase in hyperglycemia (OR1.38, 95% CI, 1.12,1.71;p = 0.003) and reduced DKA (OR 0.30, 95% CI, 0.12,0.73;p = 0.009) during the pandemic compared to the pre-pandemic phase. Stable rates of hospitalization (OR0.57, 95% CI, 0.31,1.04, p = 0.068) and hypoglycemia (OR1.11, 95% CI, 0.83,1.49;p = 0.484) were noted. These results were retained in the sensitivity analysis. Conclusions Glycemic control in children with T1DM remained stable during the first year of the pandemic. There were more newly diagnosed patients during the pandemic compared to the pre-pandemic phase, and more of these new patients presented in DKA. The latter presentation was reduced in those with established diabetes during the same period. Further studies are needed to assess the ongoing impact of the COVID-19 pandemic on T1DM care pathways and outcomes to allow children, families, and diabetes teams to personalize choices of care models.
ABSTRACT
Background: Obesity is a global public health concern. Given the widespread disruption caused by the SARS-CoV-2 pandemic, it is important to evaluate its impact on children with chronic health conditions. This study examines the health of paediatric patients with obesity enrolled in a tertiary hospital weight management program, before and 1 year into the COVID-19 pandemic. Methods: This is a retrospective chart review of patients aged 2 to 17 years enrolled in a paediatric weight management clinic. Mental health outcomes (i.e., new referrals to psychologist, social work, eating disorder program, incidence of dysregulated eating, suicidal ideation, and/or self-harm) and physical health (anthropometric measures) were compared before and 1 year into the pandemic. Results: Among the 334 children seen in either period, there was an increase in referrals to psychologist (12.4% versus 26.5%; P=0.002) and the composite mental health outcome (17.2% versus 30.2%; P=0.005) during the pandemic compared with pre-pandemic. In a subset of children (n=30) with anthropometric measures in both periods, there was a lower rate of decline in BMIz score (-1.5 [2.00] versus -0.3 [0.73]/year; P=0.002) and an increase in adiposity (-0.8 [4.64] versus 2.7 [5.54]%/year; P=0.043) during the pandemic. Discussion: The pandemic has impacted the mental and physical health of children with obesity engaged in a weight management clinic. While our study provides evidence of a negative impact on mental health outcomes and less improvement in anthropometric measures, future research when patients return to in-person care will enable further examination of our findings with additional objective measures.