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

Nicholas D Clement; Sam Oussedik; Kamran I Raza; Robyn F L Patton; Karen Smith; David J Deehan

doi:10.1302/2633-1462.110.BJO-2020-0135.R1

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

Bone Jt Open. 2020 Oct 21;1(10):663-668. doi: 10.1302/2633-1462.110.BJO-2020-0135.R1. eCollection 2020 Oct.

Authors

Nicholas D Clement^{1

2}, Sam Oussedik³, Kamran I Raza², Robyn F L Patton⁴, Karen Smith¹, David J Deehan¹

Affiliations

¹ Department of Orthopaedics, Freeman Hospital, Newcastle, United Kingdom.
² Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
³ Department of Orthopaedics, University College Hospital, London, United Kingdom.
⁴ Medical School; Biomedical Sciences, Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.

PMID: 33215099
PMCID: PMC7659700
DOI: 10.1302/2633-1462.110.BJO-2020-0135.R1

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.

Keywords: COVID-19; Deferral; Delay; Elective; Pandemic.