PMID- 33309899 OWN - NLM STAT- MEDLINE DCOM- 20210208 LR - 20231208 IS - 1532-0480 (Electronic) IS - 1532-0464 (Print) IS - 1532-0464 (Linking) VI - 113 DP - 2021 Jan TI - A retrospective approach to evaluating potential adverse outcomes associated with delay of procedures for cardiovascular and cancer-related diagnoses in the context of COVID-19. PG - 103657 LID - S1532-0464(20)30285-9 [pii] LID - 10.1016/j.jbi.2020.103657 [doi] AB - OBJECTIVE: During the COVID-19 pandemic, health systems postponed non-essential medical procedures to accommodate surge of critically-ill patients. The long-term consequences of delaying procedures in response to COVID-19 remains unknown. We developed a high-throughput approach to understand the impact of delaying procedures on patient health outcomes using electronic health record (EHR) data. MATERIALS AND METHODS: We used EHR data from Vanderbilt University Medical Center's (VUMC) Research and Synthetic Derivatives. Elective procedures and non-urgent visits were suspended at VUMC between March 18, 2020 and April 24, 2020. Surgical procedure data from this period were compared to a similar timeframe in 2019. Potential adverse impact of delay in cardiovascular and cancer-related procedures was evaluated using EHR data collected from January 1, 1993 to March 17, 2020. For surgical procedure delay, outcomes included length of hospitalization (days), mortality during hospitalization, and readmission within six months. For screening procedure delay, outcomes included 5-year survival and cancer stage at diagnosis. RESULTS: We identified 416 surgical procedures that were negatively impacted during the COVID-19 pandemic compared to the same timeframe in 2019. Using retrospective data, we found 27 significant associations between procedure delay and adverse patient outcomes. Clinician review indicated that 88.9% of the significant associations were plausible and potentially clinically significant. Analytic pipelines for this study are available online. CONCLUSION: Our approach enables health systems to identify medical procedures affected by the COVID-19 pandemic and evaluate the effect of delay, enabling them to communicate effectively with patients and prioritize rescheduling to minimize adverse patient outcomes. CI - Copyright (c) 2020 Elsevier Inc. All rights reserved. FAU - Zheng, Neil S AU - Zheng NS AD - Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA. FAU - Warner, Jeremy L AU - Warner JL AD - Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. FAU - Osterman, Travis J AU - Osterman TJ AD - Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. FAU - Wells, Quinn S AU - Wells QS AD - Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. FAU - Shu, Xiao-Ou AU - Shu XO AD - Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. FAU - Deppen, Stephen A AU - Deppen SA AD - Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. FAU - Karp, Seth J AU - Karp SJ AD - Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. FAU - Dwyer, Shon AU - Dwyer S AD - Vanderbilt University Adult Hospital, Vanderbilt University Medical Center, Nashville, TN, USA. FAU - Feng, QiPing AU - Feng Q AD - Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. FAU - Cox, Nancy J AU - Cox NJ AD - Department of Pharmacology, Vanderbilt University, Nashville, TN, USA; Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA. FAU - Peterson, Josh F AU - Peterson JF AD - Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. FAU - Stein, C Michael AU - Stein CM AD - Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pharmacology, Vanderbilt University, Nashville, TN, USA. FAU - Roden, Dan M AU - Roden DM AD - Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pharmacology, Vanderbilt University, Nashville, TN, USA. FAU - Johnson, Kevin B AU - Johnson KB AD - Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA. FAU - Wei, Wei-Qi AU - Wei WQ AD - Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: wei-qi.wei@vumc.org. LA - eng GR - R01 GM120523/GM/NIGMS NIH HHS/United States GR - R25 GM062459/GM/NIGMS NIH HHS/United States GR - R01 HL133786/HL/NHLBI NIH HHS/United States GR - P30 CA068485/CA/NCI NIH HHS/United States GR - P50 GM115305/GM/NIGMS NIH HHS/United States GR - U01 HG011166/HG/NHGRI NIH HHS/United States GR - U01 HG011181/HG/NHGRI NIH HHS/United States GR - UL1 TR000445/TR/NCATS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20201210 PL - United States TA - J Biomed Inform JT - Journal of biomedical informatics JID - 100970413 SB - IM MH - Adult MH - COVID-19/*epidemiology/virology MH - Cardiovascular Diseases/*diagnosis/*surgery MH - Female MH - Humans MH - Male MH - Middle Aged MH - Neoplasms/*diagnosis/*surgery MH - *Pandemics MH - Retrospective Studies MH - SARS-CoV-2/isolation & purification MH - *Time-to-Treatment PMC - PMC7728428 OTO - NOTNLM OT - COVID-19 OT - Electronic health records OT - Procedure delay COIS- The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2020/12/15 06:00 MHDA- 2021/02/09 06:00 PMCR- 2020/12/10 CRDT- 2020/12/14 10:17 PHST- 2020/07/11 00:00 [received] PHST- 2020/10/10 00:00 [revised] PHST- 2020/12/07 00:00 [accepted] PHST- 2020/12/15 06:00 [pubmed] PHST- 2021/02/09 06:00 [medline] PHST- 2020/12/14 10:17 [entrez] PHST- 2020/12/10 00:00 [pmc-release] AID - S1532-0464(20)30285-9 [pii] AID - 103657 [pii] AID - 10.1016/j.jbi.2020.103657 [doi] PST - ppublish SO - J Biomed Inform. 2021 Jan;113:103657. doi: 10.1016/j.jbi.2020.103657. Epub 2020 Dec 10.