Patient-reported impact of having surgery delayed during the COVID-19 pandemic

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the coronavirus (COVID-19) pandemic, which overburdened healthcare systems globally. Several jurisdictions reduced the load of surgeries to reallocate healthcare resources to emergency care for COVID-19. This hasty decision led to a staggering number of non-urgent surgeries. The impact of delaying 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 clear.

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

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

There is a knowledge gap 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, recurrent lockdowns, and shortage of medical facilities, delayed surgeries have also been on the rise. Researchers recently published a study in the preprint server medRxiv* to address this knowledge gap and understand the scope of the personal impact on patients and their daily lives due to delayed surgeries.

Study details

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

Survey recruitment was done through posters distributed through social media (Twitter, Facebook, Instagram) and local news outlets. Research facilitators who volunteered to interview the 16 candidates were female graduate students and a research associate with experience in qualitative methods, but not within the area of surgical care or COVID-19, who volunteered to conduct the interviews. The experienced facilitator used a semi-structured interview guide, and two independent reviewers analyzed the responses.

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

On interviewing the candidates, the facilitators derived upon four themes causing individual-level impacts (physical health, mental health, family and friends, work, quality of life), system-level factors (healthcare resources, communication, perceived accountability/responsibility), unique issues related to COVID-19, and uncertainty.

The physical effect of delaying surgery has been previously illustrated in other studies, and data shows that it has only led to reduced life expectancy and deterioration in the quality of life, among other socio-economic constraints. Delaying non-urgent surgeries was associated with an increased cost to patients (e.g., increased pain, decreased quality of life) and the healthcare system. This study further confirmed that perceived physical health was compromised due to the delays in surgery. However, the physical impact was less prominent but significantly impacted the patients’ mental health and quality of life.

Uncertainty was the most prominent theme that connected multiple factors like job-related distress, mental health, and financial burdens. Minimizing uncertainty emerged as the most challenging in the context of COVID-19 because the pandemic has itself been extremely unpredictable. These findings highlight the need for timely, personalized, pragmatic, and compassionate communication to relieve some of the stress brought about by the pandemic, even if it does not imply a direct address of the pandemic and its healthcare concerns.

Implication

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

*Important notice

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