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INTRODUCTION: COVID-19 poses a special challenge for patients with inflammatory bowel disease (IBD) on biologics due to concern of higher risk for infection In an effort to limit patient exposure, our center underwent an expedited process to consider transitioning IBD patients from hospital-based infusions to home infusions In this study, we present data on barriers and delays to home infusion (HI) transitions in the setting of the COVID-19 METHODS: We performed a retrospective chart review of adult IBD patients receiving IV biologics at our hospital-based infusion center between 1/1/2020 and 5/15/2020 Patients were excluded if receiving biologics for a non-IBD indication, if receiving infusion at a different center, or if already receiving HI The primary objective was to assess barriers to HI transition The secondary objectives were to identify delays in receiving HI and factors contributing to delayed HI A HI was considered delayed if there was a delay of greater than 3 days from the planned infusion due date RESULTS: 149/400 patients met the inclusion criteria Patients were categorized into 3 groups 1) 70 (47 3%) patients who completed transition to HI 2) 29 patients (19 6%) who had the HI transition in process at the time of this review but were not considered delayed 3) 49 patients (33 1%) who did not undergo HI transition Those who completed HI transition, 68/70 (97 1%) were aged 65 or less 16/70 (22 9%) patients experienced a delay in receiving HI Median HI delay time was 7 days (range: 5 5-12 0) COVID-19 contributed to HI delay in 3/16 (18 75%), either due to confirmed testing or contact with a positive case 11/16 patients (68 75%) had no clearly documented or identifiable reason for the HI delay In 40/49 patients (81 6%) who did not complete transition to HI, Medicare insurance was identified as the barrier to HI Patient preference against HI was identified in 5/49 (10 2%) as a barrier CONCLUSION: The main barrier to HI transition was Medicare A successful HI transition was accomplished in the majority of the patients without any delay About one-fourth of the patients experienced HI delay, with a small proportion attributed to COVID-19 A small subset of those who did not transition had a personal preference against HI transition The expedited process of tran-sitioning to HI was considered successful, though it requires further assessment for cost-effectiveness and long-term safety outcomes in the setting of COVID-19

Introduction: Peritoneal carcinomatosis denotes extensive tumour involvement of the peritoneum, and is often regarded as terminal. There has been a paradigm shift in treatment, with the application of cytoreductive surgery combined with intra-peritoneal chemotherapy. The extensive nature of the surgery and malignancy-associated hypercoagulable state should increase the risk of PE, which can further increase morbidity and/or mortality. Incidence and risk factors for pulmonary embolism (PE) in this population have not been investigated in detail. Aims: To establish the incidence and specific operative risk factors for developing PE in patients with peritoneal carcinomatosis post peritonectomy and peri-operative intraperitoneal chemotherapy. Methods: A cohort of 596 patients that underwent cytoreductive surgery (peritonectomy) over a 12-year period was identified using the prospective database from St George Hospital Peritonectomy Unit. A case-control study was undertaken whereby cases were defined by the development of PE within 60 days of peritonectomy. A diagnosis of PE was based on computed tomography pulmonary angiography confirmation. The prospective database was reviewed to obtain the following clinical information for both cases (with PE) and controls (without PE): length of surgery, use of hyperthermic intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC), peritoneal carcinomatosis index (PCI) and number of intraoperative blood transfusions. Results: The mean age of the cohort was 52.7 ± 13.1 years, with no significant difference in the ages of cases or controls; 43.3% were male and 56.7% were female. Primary malignancies in these patients were pseudomyxoma peritonei, appendiceal, ovarian or colorectal cancer, and mesothelioma. Out of the 596 patient cohort, 34 were identified as having PE post cytoreductive surgery (5.7%). When compared to controls, the PE group had longer mean operative time of 10.4 ± 2.8 hours vs 8.9 ± 3.1 hours (p=0.01) and higher mean PCI values at 23 ± 12 vs 18 ± 11 (p=0.02). An operative time of more >9 hours increased the risk of developing PE (OR 3.3, 95% CI 1.41-7.72, p=0.006) as did having a PCI of >20 (OR 2.4, 95% CI 1.18-4.9, p=0.02). There was no difference in mean transfusion requirements (6.6 vs 6.0; p=0.67). No significant association was found between HIPEC and development of PE (x2=2.87, 1 df, P=0.9) or EPIC and subsequent PE (x2=0.001, 1 df, P=1). Conclusions: There is a relatively high incidence of pulmonary embolism in patients following cytoreductive surgery for peritoneal carcinomatosis. Patients at highest risk of developing PE postoperatively are those with PCI of more than 20 and those who have operations lasting more than 9 hours. Peri-operative chemotherapy and blood transfusions are not risk factors for PE.