Insights into patient preferences for elective surgery during the COVID-19 pandemic

Hotchen, Andrew J.; Khan, Saad; Khan, Maaz; Seah, Matthew; Charface, Zain H.; Khan, Zarif; Khan, Wasim; Kang, Niel; Melton, J. T. K.; McCaskie, Andrew W.; McDonnell, Susan

doi:10.1302/2633-1462.24.bjo-2020-0201

Cited by 6 publications

(4 citation statements)

References 26 publications

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“… 20 , 21 Based on EuroQol five-dimension (EQ-5D) questionnaires, 19% of those waiting for a total hip arthroplasty (THA) and 12% of those waiting for a total knee arthroplasty (TKA) are in a state described as ‘worse than death.’ 22 A recently published follow-up study conducted during the COVID-19 pandemic determined that over one-third of patients waiting for a THA and just under one-quarter waiting for a TKA are in a state of being ‘worse than death.’ 23 Wilson et al, 24 in their study assessing patient perceptions of COVID-19-related surgical delay, showed that although the vast majority of patients understood that delay was in their best interest, 68% of the patient cohort reported being in emotional distress as a result of the delay. In addition, Hotchen et al 18 showed that patients with a worse joint-specific quality of life were likely to be willing to proceed with their elective lower limb arthroplasty procedure even during higher COVID-19 alert levels (levels 3 to 5). Our results may be used to echo the findings of these studies, as 94.7% of patients waiting for a THA and 87.1% of those waiting for a TKA were happy to proceed with their operation.…”

Section: Discussionmentioning

confidence: 99%

Restarting elective orthopaedic surgery as COVID-19 lockdown restrictions are reduced

et al. 2021

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Aims The COVID-19 pandemic drastically affected elective orthopaedic services globally as routine orthopaedic activity was largely halted to combat this global threat. Our institution (University College London Hospital, UK) previously showed that during the first peak, a large proportion of patients were hesitant to be listed for their elective lower limb procedure. The aim of this study is to assess if there is a patient perception change towards having elective surgery now that we have passed the peak of the second wave of the pandemic. Methods This is a prospective study of 100 patients who were on the waiting list of a single surgeon for an elective hip or knee procedure. Baseline characteristics including age, American Society of Anesthesiologists (ASA) grade, COVID-19 risk, procedure type, and admission type were recorded. The primary outcome was patient consent to continue with their scheduled surgical procedure. Subgroup analysis was also conducted to define if any specific patient factors influenced decision to continue with surgery Results Overall, 88 patients (88%) were happy to continue with their scheduled procedure at the earliest opportunity. Patients with an ASA grade I were most likely to agree to surgery, followed by patients with ASA grades II, then those with grade III (93.3%, 88.7%, and 78.6% willingness, respectively). Patients waitlisted for an injection were least likely to consent to surgery, with just 73.7% agreeing. In all, there was a large increase in the proportion of patient willingness to continue with surgery compared to our initial study during the first wave of the pandemic. Conclusion As COVID-19 lockdown restrictions are lifted after the second peak of the pandemic, we are seeing greater willingness to continue with scheduled orthopaedic surgery, reinforcing a change in patient perception towards having elective surgery. However, we must continue with strict COVID-19 precautions in order to minimize viral transmission as we increase our elective orthopaedic services going forward. Cite this article: Bone Jt Open 2021;2(10):865–870.

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Section: Discussionmentioning

confidence: 99%

Restarting elective orthopaedic surgery as COVID-19 lockdown restrictions are reduced

et al. 2021

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“…There have been several studies, since the beginning of the pandemic, which have investigated the impact of delays on patients waiting for different elective procedures, such as cataract surgery, arthroplasty, and bariatric surgery. [4] , [5] , [6] , [7] , [8] , [9] , [10] A national survey of orthodontic patients in active treatment revealed that 49% of patients were very worried about not being followed-up during the pandemic and wanted to see their orthodontist soon. Their main concern related to treatment duration being extended (73%), followed by worries about “things that are not supposed to happen” to their teeth.…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on orthognathic patients: What have we learned?

Wemyss

Benington

Chung

et al. 2022

British Journal of Oral and Maxillofacial Surgery

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Background Due to the COVID-19 pandemic orthognathic surgery was suspended in the UK. The effect this had on patients, to date, is unknown. Aim: A multi-centre, cross-sectional survey was conducted in the UK to investigate the health-related impact for patients on the orthognathic surgery pathway, including those on the waiting list for surgery . Method : A structured questionnaire was designed to explore the impact of the pandemic on the patients whose orthognathic treatment was temporarily cancelled. Results: Ninety-five questionnaires were returned giving a response rate of 65%. When asked if the delay due to the pandemic had caused emotional distress, 63% (51/81) agreed. Respondents experienced more distress, in relation to dental appearance (60%, 51/83), self-confidence (52% 50/83), facial appearance (53%, 44/83) and ability to eat and chew (59%, 50/83) during the pandemic. One hundred percent of patients would have had appliances fitted or their appliances adjusted during the pandemic and 93% percent of patients stated that they would attend for surgery if they were offered this during the pandemic. In conclusion, patients appear to have experienced emotional distress in relation to the delay with their orthognathic treatment. The patients should be given greater priority, during the remobilisation of elective surgery. They should have access to ongoing psychological support, where delays affect their treatment. The “surgery-first” approach may be considered, for suitable patients, to minimise the duration of the treatment journey.

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“… 3 It has been conclusively shown that hip and knee arthroplasty procedures dramatically improve quality of life, and that patients with more advanced arthritis are more willing to accept COVID-19 risks. 4 , 5 Studies have shown increased mortality rates and postoperative complications in patients with confirmed positive COVID-19 polymerase chain reaction (PCR) test results in the perioperative period. 6 , 7 There is a lack of large-scale reporting of COVID-19 experience specifically relating to elective orthopaedic surgery.…”

Section: Introductionmentioning

confidence: 99%

Resuming elective orthopaedic services during the COVID-19 pandemic

et al. 2021

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Aims The aim of this study was to surveil whether the standard operating procedure created for the NHS Golden Jubilee sufficiently managed COVID-19 risk to allow safe resumption of elective orthopaedic surgery. Methods This was a prospective study of all elective orthopaedic patients within an elective unit running a green pathway at a COVID-19 light site. Rates of preoperative and 30-day postoperative COVID-19 symptoms or infection were examined for a period of 40 weeks. The unit resumed elective orthopaedic services on 29 June 2020 at a reduced capacity for a limited number of day-case procedures with strict patient selection criteria, increasing to full service on 29 August 2020 with no patient selection criteria. Results A total of 2,373 cases were planned in the 40-week study period. Surgery was cancelled in 59 cases, six (10.2%) of which were due to having a positive preoperative COVID-19 screening test result. Of the remaining 2,314, 996 (43%) were male and 1,318 (57%) were female. The median age was 67 years (interquartile range 59.2 to 74.6). The median American Society of Anesthesiologists grade was 2. Hip and knee arthroplasties accounted for the majority of the operations (76%). Six patients tested positive for COVID-19 preoperatively (0.25%) and 39 patients were tested for COVID-19 within 30 days after discharge, with only five patients testing positive (0.22%). Conclusion Through strict application of a COVID-19 green pathway, elective orthopaedic surgery could be safely delivered to a large number of patients with no selection criteria. Cite this article: Bone Jt Open 2021;2(11):951–957.

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Insights into patient preferences for elective surgery during the COVID-19 pandemic

Cited by 6 publications

References 26 publications

Restarting elective orthopaedic surgery as COVID-19 lockdown restrictions are reduced

Restarting elective orthopaedic surgery as COVID-19 lockdown restrictions are reduced

Impact of the COVID-19 pandemic on orthognathic patients: What have we learned?

Resuming elective orthopaedic services during the COVID-19 pandemic

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