Patient reported outcomes from elective surgery delays due to COVID-19

Introduction: Constraints used by the COVID-19 pandemic shifted clinical equipoise for a period of time by creating situations where surgery was temporarily not a choice. In this study, we conducted patient interviews to understand how limited access during the pandemic affected patient outcomes and decision making. Method: Within the 24-hospital Intermountain health care system, we examined patients scheduled for 1 of the 5 most common elective otolaryngology procedures: adenotonsillectomy, tympanostomy tube placement, septorhinoplasty and turbinate reduction, endoscopic sinus surgery, and thyroidectomy between March 14, 2020, and May 31, 2020, whose operation was postponed but not rescheduled as of September 15, 2020. We then conducted semistructured interviews with these patients or caregivers to assess patient experience and consequences of surgical delays. Interview transcripts were then analyzed for key themes. Results: From March 14, 2020, to May 31, 2020, otolaryngology procedure volume decreased by 74.3% compared with 2019 (3823 vs 967). and volumes for all of 2020 were 28.6% lower than 2019 (17,260 vs 12,327). Of the 808 patients with a scheduled operation that was postponed early in the pandemic, 288 patients (35%) had not yet rescheduled their planned procedure. We contacted 40 of these patients. Of those patients, 8 underwent their planned procedure with the original surgeon. In the remaining 32 patients, 27.5% (11) reported their condition improved or resolved completely and no longer required surgery. However, 27.5% (11) reported their health was negatively affected by delays. Patients also cited pandemic-related concerns (22.5%), financial concerns (15%), and other changes in life circumstances (15%) as keeping them from rescheduling their operation. Conclusion: We have identified instances of patient-reported harm from untreated surgical problems related to postponed surgery during the pandemic. However, we also found patients who improved without undergoing their planned procedures, which may inform opportunities of improved preoperative shared decision making.