COVID-19-related cancellation of elective orthopaedic surgery caused increased pain and psychosocial distress levels

Abstract

Purpose Health 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. Methods For 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. Results Seventy-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. Conclusion Cancellation 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 evidence Level III.

Preoperative patients’ health decrease moderately, while hospital costs increase for hip and knee replacement due to the first COVID-19 lockdown in Germany

“…Increased pain was also found by Knebel et al [ 11 ], but higher use of pain medication was not found. The dimension of anxiety/depression in the EQ-5D-5L was not significant, which strengthens the results from Endstrasser et al [ 6 ] who found no influence on mental health and was partly in line with Knebel et al [ 11 ] who found psychosocial distress only for middle-aged women. Given that the minimum clinically important difference (MCID) for the WOMAC Score ranging between 2 and 10 points (Siviero et al [ 24 ], Clement et al [ 3 ]), the 4.7 points found in this study is right in between, thus casting doubt on clinical relevance.…”

“…The limited literature about COVID-19 and preoperative health, measured using patient-reported outcome measurements (PROM), indicated increasing pain for postponed patients, decreasing physical function and activity, and ambiguous results for mental health [ 6 , 11 ]. However, a small sample size study indicated increasing health-related quality of life (HRQoL) [ 14 ].…”

Die Auswirkungen der COVID-19-Pandemie aus der Sicht ambulanter Krebspatienten

“…Das Vertrauen in das deutsche Gesundheitssystem, in die behandelnde Klinik und in die behandelnden Ärztinnen und Ärzte war in der vorliegenden Stichprobe hoch. Dies zeigte sich auch in anderen Patientengruppen 30 .…”

Die Auswirkung des Lockdowns während der COVID-19-Pandemie auf die Versorgung von elektiven Patienten (C-elective-Studie)

“…Erste Studien aus der Orthopädie in Deutschland zeigen, dass eine Verschiebung von Operationen zusätzliche Schmerzen und Analgetikaeinnahme verursachten [20]. Für Tumorerkrankungen und deren Behandlung liegen mittlerweile Daten vor, dass die Verschiebung der indizierten Therapie erheblichen negativen Einfluss auf die Prognose und das Langzeitüberleben zeigt [21].…”