The rate of patient deferral and barriers to going forward with elective orthopaedic surgery during the COVID-19 pandemic

Abstract

Aims The primary aim was to assess the rate of patient deferral of elective orthopaedic surgery and whether this changed with time during the coronavirus disease 2019 (COVID-19) pandemic. The secondary aim was to explore the reasons why patients wanted to defer surgery and what measures/circumstances would enable them to go forward with surgery. Methods Patients were randomly selected from elective orthopaedic waiting lists at three centres in the UK in April, June, August, and September 2020 and were contacted by telephone. Patients were asked whether they wanted to proceed or defer surgery. Patients who wished to defer were asked seven questions relating to potential barriers to proceeding with surgery and were asked whether there were measures/circumstances that would allow them to go forward with surgery. Results There was a significant decline in the rate of deferral for surgery from April (n = 38/50, 76%), June (n = 68/233, 29%), to August (n = 6/50, 12%) and September (n = 5/100, 5%) (p < 0.001). Patients wishing to defer were older (68 years (SD 10.1) vs 65 (SD 11.9)), more likely to be female (65% (44/68) vs 53% (88/165)) and waiting for a knee arthroplasty (65% (44/68) vs 41% (67/165); p < 0.001). By September 2020, all patients that deferred in June at one centre had proceeded or wanted to proceed with surgery due to a perceived lower risk of acquiring COVID-19 perioperatively (68%, n = 15) or because their symptoms had progressed (32%, n = 7). The most common reason (n = 14/17, 82%) for patients deferring surgery in September was the perceived risk of acquiring COVID-19 while as an inpatient. When asked what measures or circumstances would enable them to proceed with surgery, the most common (n = 7, 41%) response was reassurance of a COVID-19 free hospital. Conclusion The rate of deferral fell to 5% by September, which was due to a lower perceived risk of contracting COVID-19 perioperatively or worsening of symptoms while waiting. The potential of a COVID-19-free hospital and communication of mortality risk may improve a patient’s willingness to go forward with surgery. Cite this article: Bone Joint Open 2020;1-10:663–668.

National operating volume for primary hip and knee arthroplasty in the COVID-19 era: a study utilizing the Scottish arthroplasty project dataset

“…It has been hypothesized that patients may choose to delay, or even permanently postpone, elective arthroplasty during a global pandemic. However, Clement et al 28 demonstrated that by September 2020, the majority of patients wished to proceed with their elective orthopaedic surgery. Uncertainty regarding the numbers of patients waiting for surgery may underestimate the true scale of the problem facing elective orthopaedics in Scotland.…”

Antecedents of Individuals’ Concerns Regarding Hospital Hygiene and Surgery Postponement During the COVID-19 Pandemic: Cross-sectional, Web-Based Survey Study

“…Therefore, it is reasonable to assume that older people are more likely to postpone surgeries and operations due to the COVID-19 pandemic, as they are more susceptible to the disease than middle-aged people. Older people also have stronger health care needs than middle-aged people [ 17 ]. Further research on the COVID-19–related concerns of older individuals is needed.…”

“…They might also influence people’s health-related decisions. Specifically, these factors may directly affect anticipated behaviors that relate to people’s decisions to postpone a nonurgent surgery [ 12 , 17 ]. Therefore, this survey study aims to identify the key factors that are associated with hospitalization-related and medical service–related affective reactions and anticipated behaviors during the COVID-19 pandemic.…”

Antecedents of Individuals’ Concerns Regarding Hospital Hygiene and Surgery Postponement During the COVID-19 Pandemic: Cross-sectional, Web-Based Survey Study (Preprint)

“…They might also influence people's health-related decisions. Specifically, these factors may directly affect anticipated behaviors that relate to people's decisions to postpone a nonurgent surgery [12,17]. Therefore, this survey study aims to identify the key factors that are associated with hospitalization-related and medical service-related affective reactions and anticipated behaviors during the COVID-19 pandemic.…”