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Published on: May 26, 2023
Insights into patient preferences for elective surgery during the COVID-19 pandemic
Andrew James Hotchen1,2, Saad A Khan3, Maaz A Khan3
1Division of Trauma and Orthopaedic Surgery, Department of Surgery, University of Cambridge, Cambridge, UK.
Insights
Patient decisions on attending arthroplasty were significantly impacted by the COVID-19 pandemic. Worse joint quality of life increased willingness to undergo surgery, especially in COVID-light settings.
Area of Science:
- Orthopedic Surgery
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic disrupted elective surgical procedures, including hip and knee arthroplasty.
- Patient willingness to attend hospital for surgery was a key concern during the pandemic.
Purpose of the Study:
- To investigate factors influencing patient decisions regarding arthroplasty attendance during the COVID-19 pandemic.
- To assess patient preferences for surgery timing based on COVID-19 alert levels and hospital setting.
Main Methods:
- A postal questionnaire surveyed patients awaiting hip or knee arthroplasty in a UK tertiary center.
- Assessed patient factors, global quality of life (EQ-5D-3L), joint-specific quality of life (Oxford Hip or Knee Score), and willingness to attend surgery at different COVID-19 alert levels.
- Multivariate logistic regression identified independent predictors of attendance decisions.
Main Results:
- 400 out of 540 (74.1%) patients completed the survey.
- Less than half (48.2%) were willing to attend for arthroplasty during active COVID-19 circulation (alert levels 3-5).
- Patients with poorer joint-specific quality of life were more likely to proceed with surgery at higher alert levels, an effect amplified by the availability of private, "COVID-light" hospital options.
Conclusions:
- Patient decisions regarding elective arthroplasty are significantly influenced by the COVID-19 pandemic.
- Patient involvement is crucial for optimizing elective surgery provision during public health crises.
- Understanding patient preferences is key to safely resuming elective orthopedic procedures.
Aims:
To investigate factors that contribute to patient decisions regarding attendance for arthroplasty during the COVID-19 pandemic.
Methods:
A postal questionnaire was distributed to patients on the waiting list for hip or knee arthroplasty in a single tertiary centre within the UK. Patient factors that may have influenced the decision to attend for arthroplasty, global quality of life (QoL) (EuroQol five-dimension three-level (EQ-5D-3L)), and joint-specific QoL (Oxford Hip or Knee Score) were assessed. Patients were asked at which 'COVID-alert' level they would be willing to attend an NHS and a "COVID-light" hospital for arthroplasty. Independent predictors were assessed using multivariate logistic regression.
Results:
Of 540 distributed questionnaires, 400 (74.1%; 236 awaiting hip arthroplasty, 164 awaiting knee arthroplasty) complete responses were received and included. Less than half (48.2%) were willing to attend for hip or knee arthroplasty while a UK COVID-19 epidemic was in circulation (COVID-alert levels 3 to 5). Patients with worse joint-specific QoL had a preference to proceed with surgery at COVID-alert levels 3 to 5 compared to levels 1 and 2 (hip arthroplasty odds ratio (OR) 1.54 (95% confidence interval (CI) 1.45 to 1.63); knee arthroplasty OR 1.16 (1.07 to 1.26)). The odds of patients with worse joint-specific QoL being willing to attend for surgery at COVID-alert levels 3 to 5 increased further if surgery in a private, "COVID-light" hospital was available (hip arthroplasty OR 3.50 (95% CI 3.26 to 3.71); knee arthroplasty OR 1.41 (95% CI 1.29 to 1.53).
Conclusion:
Patient decisions surrounding elective surgery have been influenced by the global COVID-19 pandemic, highlighting the importance of patient involvement in ensuring optimized provision of elective surgery during these challenging times. Cite this article: Bone Jt Open 2021;2(4):261-270.
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