Patient-reported impact of postponing surgery during the COVID-19 pandemic

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the coronavirus (COVID-19) pandemic, which has overwhelmed healthcare systems around the world. Several jurisdictions have reduced the number of surgeries to reallocate health care resources to emergency care for COVID-19. This hasty decision resulted in an impressive number of elective surgeries. The impact of postponing such surgeries in Canada has not been fully explored, but it is estimated that clearing the backlog due to the first wave of COVID-19 may take up to 84 weeks.


To study: “It affects every aspect of your life”: A qualitative study of the impact of postponing surgery during COVID-19. Image Credit: Photoroyalty/Shutterstock


Pre-pandemic studies suggest that increased surgical wait times may contribute to poor physical health, increased anxiety, decreased social interactions, ability to work, and overall quality of life. Factors that mediate the impact of delays in accessing surgical care include patient choice in the delay and communication of healthcare providers.


There is a lack of knowledge regarding the similarity between pre-pandemic factors delaying surgeries and surgeries delayed in the context of the COVID-19 pandemic. With the unpredictability of the pandemic, recurring lockdowns and shortage of medical facilities, delayed surgeries have also increased. Researchers recently published a study on the preprint server medRxiv* to fill this knowledge gap and understand the extent of the personal impact on patients and their daily lives due to delayed surgeries.


Study details


The researchers adopted an interpretative and descriptive approach as their methodological framework and used a theoretical sampling strategy for this study. They collected data to obtain a purposive sample of anticipated variations in participants’ responses based on age, gender, type of surgery and geographic location. The study population included patients and family members/caregivers of Alberta patients whose surgery was delayed due to the response to the COVID-19 pandemic. There was an estimated 60-70% reduction in surgical capacity.


Recruitment for the survey was done through posters distributed on social media (Twitter, Facebook, Instagram) and local media. The research facilitators who volunteered to interview the 16 candidates were graduate students and a research associate with experience in qualitative methods, but not in surgical care or COVID-19, which is volunteered to conduct the interviews. The experienced facilitator used a semi-structured interview guide and two independent reviewers analyzed the responses.


The average age of participants was 47, with the majority being women with delayed surgeries. Four participants completed their surgery before the interview, while nine did not. The final themes were determined by consensus among the reviewers. The results were reviewed by the interview facilitators and three participants to ensure the reliability of the conclusions and to eliminate any bias.


During interviews with candidates, facilitators identified four themes with individual-level impacts (physical health, mental health, family and friends, work, quality of life), system-level factors (health care resources, communication, perceived accountability/responsibility), unique COVID-19 issues and uncertainty.


The physical effect of postponing surgery has already been illustrated in other studies, and the data shows that it only led to a reduction in life expectancy and a deterioration in the quality of life, between other socio-economic constraints. Postponing elective surgeries was associated with increased costs to patients (eg, increased pain, decreased quality of life) and to the health care system. This study further confirmed that perceived physical health was compromised due to delays in surgery. However, the physical impact was less significant but had a significant impact on patients’ mental health and quality of life.


Uncertainty was the most important theme that linked several factors such as work-related distress, mental health and financial burdens. Minimizing uncertainty has emerged as the most difficult in the context of COVID-19, as the pandemic itself has been extremely unpredictable. These results highlight the need for timely, personalized, pragmatic and compassionate communication to relieve some of the stress caused by the pandemic, even if it does not involve a direct response to the pandemic and its health problems.


Involvement


Studies like these suggest that careful strategies should be implemented to educate patients about the potential physical and mental consequences of waiting for surgery and to make them aware of the consequences. However, the method of communication and advice must be optimized by trials. Healthcare providers and mental health support groups (e.g., self-management approaches and peer support) also need to be made aware of these consequences to potentially lessen the burden of uncertainty and delayed surgeries. on patient health.


*Important Notice


medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice/health-related behaviors, or treated as established information.

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