The Impact of Elective Surgical Restriction during the COVID-19 Pandemic in Shoulder and Elbow Surgery: patient perceptions.

Abstract

In late 2019 and early 2020 a novel coronavirus (Covid-19) spread across the world creating a global pandemic. In the state of Pennsylvania, non-emergent, elective operations were temporarily delayed from proceeding with normal standard of care. The primary purpose of this study was to determine the proportion of patients who required prescription pain medication during the surgical delay. Secondarily, we sought to determine the proportion of patients who perceived their surgery as non-elective and evaluate how symptoms were managed during the delay. A single institutional database was used to retrospectively identify all shoulder and elbow surgeries scheduled between March 13, 2020 and May 6, 2020. Charts were manually reviewed. Patients who underwent non-shoulder and elbow related procedures and patients of surgeons outside of Pennsylvania were excluded. Patients whose surgeries were "postponed" or "canceled" were administered a survey evaluating how symptoms were managed and perceptions regarding the delay. Preoperative functional scores were collected. Statistical analysis was performed to determine associations between procedure status, preoperative functional scores, perception of surgery, and requirement for prescription pain medication. 338 patients were scheduled for shoulder/elbow surgery at our practice in Pennsylvania. 89 patients (26.3%) underwent surgery as initially scheduled. 179 patients (71.9%) had their surgeries postponed. 70 patients (28.1%) canceled surgery. The average delay in surgery was 86.7 days (range, 13-299 days). 176 (70.7%) patients who were postponed or canceled responded to the survey. 39 patients (22.2%) required prescription pain medication during the delay. 73 patients (41%) considered their procedure to be elective in nature. 137 patients (78%) would have moved forward with surgery if done safely under appropriate medical guidelines. Lower preoperative ASES and SANE scores (r= -0.36, p<0.001; r=-0.26, p=0.016, respectively), and higher preoperative VAS scores were correlated with requiring prescription pain medication (r=0.28, p=0.009). Higher preoperative ASES score was positively correlated with perception of surgery as elective (r=0.4; p<0.001). Patients undergoing elective shoulder and elbow surgery during the Covid-19 pandemic experienced a delay of nearly 3 months on average. Fewer than half of patients perceived their surgeries as elective procedures. Nearly a quarter of patients surveyed required extra prescription pain medicine during their delay. This study elucidates the fact that while orthopedic shoulder and elbow surgery is generally considered "elective" it is more important to a majority of patients. These findings may also be applicable to future potential mandated surgical care delays by other third- party organizations.