This survey was conducted by NORC at the University of Chicago. Data were collected using the AmeriSpeak panel, NORC's probability based panel designed to be representative of the U.S. household population. Panel members were randomly drawn from AmeriSpeak. The final stage completion rate is 33.9%. The overall margin of sampling error is +/-4.28 percentage points at the 95 percent confidence level, including the design effect. The margin of sampling error may be higher for subgroups. Once the sample has been selected and fielded, and all the study data have been collected and made final, a post-stratification process is used to adjust for any survey nonresponse as well as any non-coverage or under and oversampling resulting from the study specific sample design. Post-stratification variables included age, gender, census division, race/ethnicity, and education. Weighting variables were obtained from the 2018 Current Population Survey. The weighted data reflects the U.S. population of adults age 70 and over. NOTE: All results show percentages among respondents, unless otherwise labeled.

Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P < 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P < 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P < 0.001). Conclusion Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection.

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BACKGROUND Telephone and video telemedicine appointments have been a crucial service delivery method during the COVID-19 pandemic to maintain access to healthcare without increasing risk of exposure. While pre-pandemic studies suggest that telemedicine is an acceptable format for older adults, there is a paucity of data on the practical implementation of telemedicine visits. Due to prior lack of reimbursement for telemedicine visits involving non-rural patients, no studies have compared telephone versus video visits in geriatric primary care. OBJECTIVE To determine whether video visits had 1) longer duration, 2) more visit diagnoses, and 3) more advance care planning discussions than telephone visits during the rapid implementation of telemedicine during the COVID-19 pandemic, and to determine whether disparities in visit type exist based on patient characteristics. METHODS We conducted a retrospective, cross-sectional analysis of patients seen at two geriatric clinics from April 23, 2020 to May 22, 2020. Approximately 25% of telephone and video appointments during this time underwent chart review. Measurements included patient characteristics, visit characteristics, duration of visits, number of visit diagnoses and presence of advance care planning discussion in clinical documentation. RESULTS Of 190 appointments reviewed, 47% were video visits. Compared to telephone appointments, those using videoconferencing were seven minutes longer (P<.001) and had 1.3 more visit diagnoses (P=.001). Video and telephone visits had similar rates of advance care planning. Having hearing, vision or cognitive impairment did not result in different rates of video or telephone appointments. Patients who were non-white, needed interpreter services or received Medicaid were less likely to have video visits (P<.001 and P=.003, respectively). CONCLUSIONS Although clinicians spent more time for video visits than telephone visits, more than half of older patients did not use video visits, especially if they were patients from racial or ethnic minority backgrounds or Medicaid beneficiaries. This potential healthcare disparity merits greater attention.