Impact of delay due to the first wave of the COVID-19 pandemic on elective surgical patients in a tertiary care center: a prospective observational study

Abstract

Background: Elective services were withheld in most parts of the world to cope with the stress on the healthcare system caused by the Coronavirus disease 2019 (COVID-19). However, delaying elective services for more than a particular duration adversely affects disease outcomes. This study aimed to assess the effect on elective surgical patients due to delays caused by withholding elective surgical services to deal with the COVID-19 pandemic at our institution. Methods: This prospective observational study included all the patients who planned and waited for elective surgery till the day elective services were withheld at our institution (24 March 2020) due to the COVID-19 pandemic. All patients were followed until the patients were operated on or three months after resuming elective operative services at our institution. These patients were assessed to determine the proportion of patients with worsening symptoms, stage progression, and needing emergency procedures or palliative surgery. Results: Breast cancer was the most common cancer among malignancy patients awaiting surgery. Compared to Breast cancer, Gastrointestinal cancers had a significantly higher proportion of patients with stage progression (61.3% vs. 90%, p=0.016) and mortality (6.5% vs. 53.3%, p<0.001). In benign patients, symptom progression was seen in 45.9%, and emergency surgery/procedures were needed in 5.4 %. Conclusions: Even though the so-called elective surgery, postponing these surgeries, particularly cancer surgeries, can compromise the outcomes of the patients if delayed for more than a certain point.