Abstract
PurposeHealth care systems in most European countries were temporarily restructured to provide as much capacity as possible for the treatment of coronavirus disease 2019 (COVID-19) patients. Subsequently, all elective surgeries had to be cancelled and postponed for months. The aim of the present study was to assess the pretreatment health status before and after COVID-19-related cancellation and the psychosocial distress caused by the cancellation.MethodsFor this study, a questionnaire was developed collecting sociodemographic data and information on health status before and after the cancellation. To assess psychosocial distress, the validated depression module of the Patient Health Questionnaire (PHQ-9), was implemented. PHQ-9-Scores of 10 and above were considered to indicate moderate or severe depressive symptoms. In total, 119 patients whose elective orthopaedic surgery was postponed due to the COVID-19 pandemic were surveyed once at least 8 weeks after the cancellation.ResultsSeventy-seven patients (65%; 34 female, 43 male) completed the questionnaire and were included. The predominant procedures were total knee arthroplasty (TKA), hip arthroscopy and foot and ankle surgery. The mean pain level significantly increased from 5.5 ± 2.2 at the time of the initially scheduled surgery to 6.2 ± 2.5 at the time of the survey (p < 0.0001). The pain level before cancellation of the surgery was significantly higher in female patients (p = 0.029). An increased analgetic consumption was identified in 46% of all patients. A mean PHQ-9 score of 6.1 ± 4.9 was found after cancellation. PHQ-9 scores of 10 or above were found in 14% of patients, and 8% exhibited scores of 15 points or above. Significantly higher PHQ-9 scores were seen in female patients (p = 0.046). No significant differences in PHQ-9 scores were found among age groups, procedures or reasons for cancellation.ConclusionCancellation of elective orthopaedic surgery resulted in pain levels that were significantly higher than when the surgery was scheduled, leading to increased analgesic use. Additionally, significant psychosocial distress due to the cancellation was identified in some patients, particularly middle-aged women. Despite these results, confidence in the national health care system and in the treating orthopaedic surgeons was not affected.Level of evidenceLevel III.
Highlights
On March 11th 2020, the World Health Organization (WHO) declared COVID-19 a pandemic due to the rapid spread around the globe
All patients (n = 119) whose elective orthopaedic surgery at a large university hospital was postponed due to the COVID-19 pandemic between March 12th and April 30th 2020 were included in the present study
The mean pain level significantly increased from 5.5 ± 2.2 at the time of the initially scheduled surgery to 6.2 ± 2.5 at the time of the survey (p < 0.0001)
Summary
On March 11th 2020, the World Health Organization (WHO) declared COVID-19 a pandemic due to the rapid spread around the globe. All elective surgeries had to be cancelled and postponed for months [7, 13, 20]. In this context, for many elective orthopaedic procedures, e.g., total hip or knee arthroplasty, it is known that longer waiting times may adversely affect the postoperative outcome [30]. Several studies have demonstrated that longer waiting times are associated with a poorer pretreatment health status [7, 8, 28]. Patients with poorer pretreatment health status may benefit more from surgery, Fielden et al demonstrated that post-treatment health status remained lower than in patients who received treatment more quickly [8]
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