Psychological distress among elderly surgical patients who had their surgery postponed during the COVID-19 pandemic

Abstract

Background Many institutions withheld elective lists and triaged surgeries during the peak of coronavirus disease 2019 (COVID-19) pandemic. As a result, older surgical patients have had to wait for rescheduled dates in a long waitlist. This study aimed to identify the psychological impact in these patients when they returned for surgery. Methods This was a cross-sectional study which included 153 patients aged ≥ 65 years undergoing elective surgery. Trained interviewers recruited and assessed psychological status pre-operatively with two validated questionnaires - Hospital Anxiety and Depression Scale (HADS) and 36-item Short Form Health Survey (SF-36). Specific questions were asked about their postponed surgeries, appetite and fear. Results A total of 36 out of 153 (23.5%) patients had their procedures deferred during the first wave of COVID-19 pandemic. Postponed cases were significantly based on the nature of surgery (p = 0.002), cancer diagnosis (p = 0.006) and surgical specialty (p = 0.023). Median HADS scores were higher for patients who were postponed (2.00 versus 4.00 for anxiety, p = 0.180 and 0.00 versus 1.00 for depression, p = 0.424) although no statistical significance was shown. In the whole study population, anxiety was a significant predictor for depression and vice versa (p < 0.001) with other predictive risk factors for anxiety that were age ≥ 85 years old (odds ratio [OR] 6.14, p = 0.018), female (OR 2.41, p = 0.024), cancer (OR 2.19, p = 0.039) and major surgery (OR 2.39, p = 0.023). Similarly, older patients ≥ 85 years old (OR 10.44, p = 0.003) and female (OR 6.07, p = 0.006) had higher risk for depression. Both anxiety and depression were significant risks for loss of appetite (p = 0.005 and 0.001). Lastly, the fear of disease progression due to rescheduling was more frequent in cancer patients (p = 0.035). Conclusion The mental health and disease burden of older surgical patients should be taken into careful consideration when cases need to be postponed in our healthcare system.

Stress, anxiety, and illness perception in patients experiencing delay in operative care due to the COVID-19 pandemic

“…( Esposito et al, 2020 , Tokgoz et al, 2020 Aug 19 , Barra et al, 2020 ) This was also seen in both the elderly population and those who had surgical delays outside of the United States. ( Loh et al, 2022 , Sauro et al, 2023 ). This highlights the generalizable distress felt by those experiencing delays during the pandemic.…”

Investigating discrepancies in demand and access for bariatric surgery across different demographics in the COVID-19 era

“…According to the Center for Disease Control (CDC), more than 40.9% of American adults delayed getting medical assistance, with 55.2% of those aged 18 to 24 showing higher COVID-19-related anxiety, whereas 65.0 and 65.3% of those aged 65 to 74 and > 75 indicated greater COVID-19-related dread [ 7 , 8 ]. Furthermore, the postponement of procedures added to the patients' worry by forcing them to treat the condition at home [ 9 ]. This might result in a cyclical loop in which anxiety disrupts visits, which causes more anxiety.…”