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Urology ; 2021 Dec 31.
Article in English | MEDLINE | ID: covidwho-1586290


OBJECTIVE: To determine the odds of accessing telemedicine either by phone or by video during the COVID-19 pandemic. METHODS: We performed a retrospective study of patients who were seen at a single academic institution for a urologic condition between March 15, 2020 and September 30, 2020. The primary outcome was to determine characteristics associated with participating in a telemedicine appointment (video or telephone) using logistic regression multivariable analysis. We used a backward model selection and variables that were least significant were removed. We adjusted for reason for visit, patient characteristics such as age, sex, ethnicity, race, reason for visit, preferred language, and insurance. Variables that were not significant that were removed from our final model included median income estimated by zip code, clinic location, provider age, provider sex, and provider training. RESULTS: We reviewed 4,234 visits: 1,567 (37%) were telemedicine in the form of video 1402 (33.1%) or telephone 164 (3.8%). The cohort consisted of 2,516 patients, Non-Hispanic White (n=1,789, 71.1%) and Hispanic (n=417, 16.6%). We performed multivariable logistic regression analysis and demonstrated that patients who were Hispanic, older, or had Medicaid insurance were significantly less likely to access telemedicine during the pandemic. We did not identify differences in telemedicine utilization when stratifying providers by their age, sex, or training type (physician or advanced practice provider). CONCLUSIONS: We conclude that there are differences in the use of telemedicine and that this difference may compound existing disparities in care. Additionally, we identified that these differences were not associated with provider attributes. Further study is needed to overcome barriers in access to telemedicine.

Urology ; 147: 50-56, 2021 01.
Article in English | MEDLINE | ID: covidwho-779729


OBJECTIVE: To test for an association between surgical delay and overall survival (OS) for patients with T2 renal masses. Many health care systems are balancing resources to manage the current COVID-19 pandemic, which may result in surgical delay for patients with large renal masses. METHODS: Using Cox proportional hazard models, we analyzed data from the National Cancer Database for patients undergoing extirpative surgery for clinical T2N0M0 renal masses between 2004 and 2015. Study outcomes were to assess for an association between surgical delay with OS and pathologic stage. RESULTS: We identified 11,848 patients who underwent extirpative surgery for clinical T2 renal masses. Compared with patients undergoing surgery within 2 months of diagnosis, we found worse OS for patients with a surgical delay of 3-4 months (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.00-1.25) or 5-6 months (HR 1.51, 95% CI 1.19-1.91). Considering only healthy patients with Charlson Comorbidity Index = 0, worse OS was associated with surgical delay of 5-6 months (HR 1.68, 95% CI 1.21-2.34, P= .002) but not 3-4 months (HR 1.08, 95% CI 0.93-1.26, P = 309). Pathologic stage (pT or pN) was not associated with surgical delay. CONCLUSION: Prolonged surgical delay (5-6 months) for patients with T2 renal tumors appears to have a negative impact on OS while shorter surgical delay (3-4 months) was not associated with worse OS in healthy patients. The data presented in this study may help patients and providers to weigh the risk of surgical delay versus the risk of iatrogenic SARS-CoV-2 exposure during resurgent waves of the COVID-19 pandemic.

COVID-19/prevention & control , Clinical Decision-Making , Kidney Neoplasms/mortality , Nephrectomy/statistics & numerical data , Time-to-Treatment/statistics & numerical data , Aged , COVID-19/epidemiology , COVID-19/transmission , Communicable Disease Control/standards , Databases, Factual/statistics & numerical data , Female , Humans , Kaplan-Meier Estimate , Kidney Neoplasms/pathology , Kidney Neoplasms/surgery , Male , Middle Aged , Mortality/trends , Neoplasm Staging , Nephrectomy/standards , Nephrectomy/trends , Pandemics/prevention & control , Proportional Hazards Models , Puerto Rico/epidemiology , Retrospective Studies , SARS-CoV-2/pathogenicity , Time Factors , Time-to-Treatment/trends , United States/epidemiology