Patient Perceptions of COVID-19-Related Surgical Delay: An Analysis of Patients Awaiting Total Hip and Knee Arthroplasty

Abstract

Background: COVID-19 has caused unprecedented delays in elective orthopedic surgery. Understanding patients' perceptions of the disruptions in care and their willingness to reengage the healthcare system are crucial to planning the resumption of elective care. Questions/ Purposes: The purpose of this study was to elicit patient perceptions about delays in total joint arthroplasty during the COVID-19 pandemic. Methods: We identified a consecutive series of patients who experienced COVID-19-driven delays to scheduled total hip or knee arthroplasty at an urban, academic medical center in the Southeastern United States. A 20-item survey was administered via telephone. Answers were recorded and descriptive statistics were performed. A post hoc χ-square analysis compared characteristics and outlooks of patients who did and did not immediately desire surgery. Results: Of 111 patients (64% of those identified) who met inclusion criteria and completed the survey, 96% said they felt that they were treated fairly and 90% said that the surgical delay was in their best interest; 68% reported emotional distress from the delay, but 45% reported a desire to wait longer for the pandemic to subside. Lower jointfunction scores, higher pain levels, higher pain catastrophizing scores, and longer latency from personally deciding to pursue surgery were associated with the reported need for immediate surgery. Conclusion: Overall, patients reported that they understood the need for elective surgical delays during the COVID-19 pandemic. However, the psychological implications they reported were not negligible. Patient preference for immediate reengagement with the healthcare system was dichotomous, with many patients favoring precautionarily furthering the delay. Understanding these preferences will help optimize elective orthopedic care during unprecedented times.

COVID-19 pandemic and elective spinal surgery cancelations – what happens to the patients?

“…These regional and age related differences in addition to the decreased length of stay for total joints cases may explain why more total joints patients reported willingness to proceed with surgery immediately compared to the spine patients in our study. In global literature for all elective orthopedic surgery cases early in the pandemic, 30% or more of patients wanted to cancel their surgeries, with the primary reason for cancelation concern for COVID-19 exposure [17,18]. This is consistent with findings in our study showing 40.8% of patients not rescheduled are deferring surgery due to concern for COVID-19 exposure in medical institutions.…”

The Effect of the COVID-19 Pandemic on Total Hip and Knee Arthroplasty Surgical Volume in 2020 in Poland

“…Furthermore, younger patients with higher pain levels and worse joint function were more eager to proceed with the surgery, despite the pandemic [27,29]. Despite the impaired quality of life, most patients awaiting total joint arthroplasty (TJA) understood the need for the surgery delay due to the pandemic and said it was in their best interest [30].…”

Impact of the 1st and 2nd Wave of the COVID-19 Pandemic on Primary or Revision Total Hip and Knee Arthroplasty—A Cross-Sectional Single Center Study

“…Elective surgeries were cancelled, cancer patients endured a delay in care, treatment and screening and even trauma patients had a delay in surgical treatment [ 6 , 7 , 8 ]. Substantial cancellations and delays of a large number of total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) was observed during the pandemic [ 9 , 10 ]. So far, only general strategies and estimations about the impact of COVID-19 have been published [ 10 , 11 , 12 ].…”