Assessing the Impact of the COVID-19 Pandemic on Emergency Department Use for Patients Undergoing Cancer-Directed Surgeries.

Antoine Eskander,Qing Li,Antonio Finelli,David R Urbach,Jonathan C Irish,Rinku Sutradhar,Alyson Mahar,Ambica Parmar,Monika K Krzyzanowska,Danny Enepekides,Julie Hallet,Alexander V Louie,Craig C Earle,Jiayue Yu,Timothy P Hanna,Nicole Look-Hong,Natalie Coburn,Simron Singh,Kelvin K Chan ,Anna J Dare ,Ian J Witterick ,Lauren Lapointe‐Shaw

doi:10.3390/curroncol29030153

Abstract

Emergency department (ED) use is a concern for surgery patients, physicians and health administrators particularly during a pandemic. The objective of this study was to assess the impact of the pandemic on ED use following cancer-directed surgeries. This is a retrospective cohort study of patients undergoing cancer-directed surgeries comparing ED use from 7 January 2018 to 14 March 2020 (pre-pandemic) and 15 March 2020 to 27 June 2020 (pandemic) in Ontario, Canada. Logistic regression models were used to (1) determine the association between pandemic vs. pre-pandemic periods and the odds of an ED visit within 30 days after discharge from hospital for surgery and (2) to assess the odds of an ED visit being of high acuity (level 1 and 2 as per the Canadian Triage and Acuity Scale). Of our cohort of 499,008 cancer-directed surgeries, 468,879 occurred during the pre-pandemic period and 30,129 occurred during the pandemic period. Even though there was a substantial decrease in the general population ED rates, after covariate adjustment, there was no significant decrease in ED use among surgical patients (OR 1.002, 95% CI 0.957–1.048). However, the adjusted odds of an ED visit being of high acuity was 23% higher among surgeries occurring during the pandemic (OR 1.23, 95% CI 1.14–1.33). Although ED visits in the general population decreased substantially during the pandemic, the rate of ED visits did not decrease among those receiving cancer-directed surgery. Moreover, those presenting in the ED post-operatively during the pandemic had significantly higher levels of acuity.

Highlights

The COVID-19 pandemic has disrupted cancer care
We further examined the pattern of Emergency department (ED) rates in our cancer-directed surgery cohort against the pattern of ED rates among all Ontarians
Higher percentages of surgeries related to breast, colorectal and genitourinary cancers were found, along with a lower percentage of melanoma-related surgeries

Summary

Introduction

The COVID-19 pandemic has disrupted cancer care. Cancer patients are a vulnerable population with increased risk of morbidity and mortality from COVID-19 [1,2]. Cancer surgery patients are at high-risk of requiring acute assessment or interventions and seeing their care disrupted by pandemic-related changes. Delays and cancellations in cancer surgery associated with the ramp down of surgical services to create capacity for COVID-19 care during the pandemic may lead to advanced presentations with high symptom burden or complications requiring urgent care. Increased use of virtual care and lack of access to physical clinics for post-surgical follow-up may translate into increased reliance on the ED for management of post-operative events [6]. This is crucial knowing that delays in surgery for cancer patients, such as the ones observed during the pandemic, lead to increased morbidity and mortality [7,8]. Little is known about ED use among patients undergoing surgery for cancer and how this may be compounded by advanced presentations and ability to access post-operative care

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