Preoperative Health During a Pandemic: An Observational Study Assessing Lifestyle Changes in Patients Associated With...

Healthcare service disruptions resulting from the COVID-19 pandemic led to substantial changes in surgical pathways across public hospitals in Western Australia (WA). These disruptions, compounded by restrictions and containment measures, influenced the health and lifestyle behaviours of the WA community, including patients awaiting surgery. This study aimed to assess changes in self-reported modifiable lifestyle risk factors among patients during COVID-19.

This observational study analysed hospital patient data across three seasonally matched calendar periods: Period 1 (January-March 2019 vs 2020), Period 2 (March-July 2019 vs 2020), and Period 3 (July-December 2019 vs 2020). Multivariable regression models were used to examine differences between these COVID‑impacted periods and preoperative self‑reported modifiable risk factors. The assessed risk factors included body mass index (BMI), smoking status, alcohol and drug use, malnutrition risk, physical function, and frailty.

Data from 2340 patients were analysed. There were no indicated changes between 2019 and 2020 cohorts in relation to body mass index (BMI), current smoking status, alcohol, or drug use, poor function or frailty risk. Change was detected in past smoker, with a higher proportion of individuals in Period 2 (Mar to Jul 2020), (8% more in 2020, 95% CI3% - 14%, p = 0.005) and Period 3 (Jul to Dec 2020) (7% more in 2020, 95% CI: 2% - 12%, p = 0.003). Also, a greater proportion of patients assessed 'at malnutrition' risk in Period 3 (13% more in 2020, 95% CI: 6% - 19%, p = 0.013).

This is the first Australian COVID-19 study to report potential pressure on the preadmission pathway for nutrition care during the COVID-19 period, with a higher proportion of patients reported to be at risk of malnutrition in later 2020. An increase in reporting of recent past smoking was observed, potentially attributable to heightened awareness of respiratory vulnerabilities associated with the virus. This study offers valuable insights to inform future pandemic planning, optimise resource allocation, and refine nutritional screening priorities. The COVID-19 pandemic has shaped a new path for innovative preoperative strategies and possible motivations for behaviour change that enhance the development of targeted prehabilitation efforts.