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

Pui San Loh; Sook Hui Chaw; Yi Xian Foong; Dhurgka Ramasamy; Rafdzah Ahmad Zaki; Shanggar Kuppusamy; Teng Aik Ong; Mee Hoong See; Hui Min Khor

doi:10.1186/s13741-022-00242-7

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

Perioper Med (Lond). 2022 Mar 17;11(1):10. doi: 10.1186/s13741-022-00242-7.

Authors

Pui San Loh¹, Sook Hui Chaw², Yi Xian Foong², Dhurgka Ramasamy², Rafdzah Ahmad Zaki³, Shanggar Kuppusamy⁴, Teng Aik Ong⁴, Mee Hoong See⁴, Hui Min Khor⁵

Affiliations

¹ Department of Anaesthesiology, Universiti Malaya, 50603, Kuala Lumpur, Malaysia. lohps@ummc.edu.my.
² Department of Anaesthesiology, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
³ Department of Social and Preventive Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
⁴ Department of Surgery, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
⁵ Department of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.

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.

Keywords: COVID-19; Depression; Elderly; Elective surgical procedures; Psychological distress, Anxiety.