Postoperative mortality and complications in patients with and without pre-operative SARS-CoV-2 infection: a service evaluation of 24 million linked records using OpenSAFELY.

Surgical decision-making after SARS-CoV-2 infection is influenced by the presence of comorbidity, infection severity and whether the surgical problem is time-sensitive. Contemporary surgical policy to delay surgery is informed by highly heterogeneous country-specific guidance. We evaluated surgical provision in England during the COVID-19 pandemic to assess real-world practice and whether deferral remains necessary. Using the OpenSAFELY platform, we adapted the COVIDSurg protocol for a service evaluation of surgical procedures that took place within the English NHS from 17 March 2018 to 17 March 2022. We assessed whether hospitals adhered to guidance not to operate on patients within 7 weeks of an indication of SARS-CoV-2 infection. Additional outcomes were postoperative all-cause mortality (30 days, 6 months) and complications (pulmonary, cardiac, cerebrovascular). The exposure was the interval between the most recent indication of SARS-CoV-2 infection and subsequent surgery. In any 6-month window, < 3% of surgical procedures were conducted within 7 weeks of an indication of SARS-CoV-2 infection. Mortality for surgery conducted within 2 weeks of a positive test in the era since widespread SARS-CoV-2 vaccine availability was 1.1%, declining to 0.3% by 4 weeks. Compared with the COVIDSurg study cohort, outcomes for patients in the English NHS cohort were better during the COVIDSurg data collection period and the pandemic era before vaccines became available. Clinicians within the English NHS followed national guidance by operating on very few patients within 7 weeks of a positive indication of SARS-CoV-2 infection. In England, surgical patients' overall risk following an indication of SARS-CoV-2 infection is lower than previously thought.

Delivering of group telehealth intervention models for teens and young adults with T1D during a pandemic

Objective: With COVID-19, many have had shelter-in-place (SIP) or physical distancing directives. Given the importance of peer support for youth with type 1 diabetes (T1D), telehealth (TH) group interventions have been beneficial. This proposal examines two TH models of group intervention for youth with T1D. The method of delivery for these interventions will be discussed. Methods: Two research teams delivered TH groups while SIP guidelines were in place. CoYoT1 to California (CTC) is a randomized control study examining an intervention for youth with T1D. It is designed to increase access to care and strengthen patient/provider satisfaction. Teen Power® is a 10-week curriculum-based group intervention for youth with T1D and their caregivers. It aims to reduce psychosocial barriers that negatively impact T1D management for youth and their families. Pre-SIP in-person and TH visits were compared including recruitment and consent methods, training requirements, and data collection. Limitations were also examined. Results: In-person and TH group process similarities/difference were identified. Broadly, the CTC team identified strengths including participants' increased familiarity downloading their diabetes data and attendance improved. For TeenPower®, a strength was the ability to offer simultaneous interpretation via chat. This allowed group cofacilitators to offer a nearly seamlessly discussion for monolingual and bilingual participants. Both teams identified needs to provide additional support to families around the use of technology. Conclusions: TH allows group interventions to be delivered to youth with T1D during a pandemic when minimal physical contact is desired. There are many benefits. Common lessons learned across groups include allowing for time to train families on technology and anticipating the need for ongoing login support for the first few sessions. Challenges included lack of privacy, as well as issues with broadband or Wi-Fi connection.