COVID-19-related cancellation of elective orthopaedic surgery caused increased pain and psychosocial distress levels.
Arthroplasty
Arthroscopy
COVID
COVID-19
Coronavirus
Depression
Orthopedic surgery
Pandemic
Psychosocial distress
SARS-CoV-2
Journal
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
ISSN: 1433-7347
Titre abrégé: Knee Surg Sports Traumatol Arthrosc
Pays: Germany
ID NLM: 9314730
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
received:
12
01
2021
accepted:
02
03
2021
pubmed:
13
3
2021
medline:
20
8
2021
entrez:
12
3
2021
Statut:
ppublish
Résumé
Health care systems in most European countries were temporarily restructured to provide as much capacity as possible for the treatment of coronavirus disease 2019 (COVID-19) patients. Subsequently, all elective surgeries had to be cancelled and postponed for months. The aim of the present study was to assess the pretreatment health status before and after COVID-19-related cancellation and the psychosocial distress caused by the cancellation. For this study, a questionnaire was developed collecting sociodemographic data and information on health status before and after the cancellation. To assess psychosocial distress, the validated depression module of the Patient Health Questionnaire (PHQ-9), was implemented. PHQ-9-Scores of 10 and above were considered to indicate moderate or severe depressive symptoms. In total, 119 patients whose elective orthopaedic surgery was postponed due to the COVID-19 pandemic were surveyed once at least 8 weeks after the cancellation. Seventy-seven patients (65%; 34 female, 43 male) completed the questionnaire and were included. The predominant procedures were total knee arthroplasty (TKA), hip arthroscopy and foot and ankle surgery. The mean pain level significantly increased from 5.5 ± 2.2 at the time of the initially scheduled surgery to 6.2 ± 2.5 at the time of the survey (p < 0.0001). The pain level before cancellation of the surgery was significantly higher in female patients (p = 0.029). An increased analgetic consumption was identified in 46% of all patients. A mean PHQ-9 score of 6.1 ± 4.9 was found after cancellation. PHQ-9 scores of 10 or above were found in 14% of patients, and 8% exhibited scores of 15 points or above. Significantly higher PHQ-9 scores were seen in female patients (p = 0.046). No significant differences in PHQ-9 scores were found among age groups, procedures or reasons for cancellation. Cancellation of elective orthopaedic surgery resulted in pain levels that were significantly higher than when the surgery was scheduled, leading to increased analgesic use. Additionally, significant psychosocial distress due to the cancellation was identified in some patients, particularly middle-aged women. Despite these results, confidence in the national health care system and in the treating orthopaedic surgeons was not affected. Level III.
Identifiants
pubmed: 33710414
doi: 10.1007/s00167-021-06529-4
pii: 10.1007/s00167-021-06529-4
pmc: PMC7952835
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2379-2385Informations de copyright
© 2021. The Author(s).
Références
Ayers DC, Franklin PD, Ploutz-Snyder R, Boisvert CB (2005) Total knee replacement outcome and coexisting physical and emotional illness. Clin Orthop Relat Res 440:157–161
doi: 10.1097/01.blo.0000185447.43622.93
Bartley EJ, Palit S, Staud R (2017) Predictors of osteoarthritis pain: the importance of resilience. Curr Rheumatol Rep 19:57
doi: 10.1007/s11926-017-0683-3
Baruch Y, Holtom BC (2008) Survey response rate levels and trends in organizational research. Human Relations 61:1139–1160
doi: 10.1177/0018726708094863
BenDebba M, Torgerson WS, Long DM (1997) Personality traits, pain duration and severity, functional impairment, and psychological distress in patients with persistent low back pain. Pain 72:115–125
doi: 10.1016/S0304-3959(97)00020-1
Brown TS, Bedard NA, Rojas EO, Anthony CA, Schwarzkopf R, Barnes CL, Parvizi J et al (2020) The effect of the COVID-19 pandemic on electively scheduled hip and knee arthroplasty patients in the united states. J Arthroplasty 35:S49–S55
doi: 10.1016/j.arth.2020.04.052
Desmeules F, Dionne CE, Belzile E, Bourbonnais R, Fremont P (2009) Waiting for total knee replacement surgery: factors associated with pain, stiffness, function and quality of life. BMC Musculoskelet Disord 10:52
doi: 10.1186/1471-2474-10-52
Donell ST, Thaler M, Budhiparama NC, Buttaro MA, Chen AF, Diaz-Ledezma C et al (2020) Preparation for the next COVID-19 wave: the european hip society and european knee associates recommendations. Knee Surg Sports Traumatol Arthrosc 28:2747–2755
doi: 10.1007/s00167-020-06213-z
Fielden JM, Cumming JM, Horne JG, Devane PA, Slack A, Gallagher LM (2005) Waiting for hip arthroplasty: economic costs and health outcomes. J Arthroplasty 20:990–997
doi: 10.1016/j.arth.2004.12.060
Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL 3rd (2009) Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain 10:447–485
doi: 10.1016/j.jpain.2008.12.001
Garbe L, Rau R, Toppe T (2020) Influence of perceived threat of Covid-19 and HEXACO personality traits on toilet paper stockpiling. PLoS ONE 15:e0234232
doi: 10.1371/journal.pone.0234232
Gregori D, Giacovelli G, Minto C, Barbetta B, Gualtieri F, Azzolina D et al (2018) Association of pharmacological treatments with long-term pain control in patients with knee osteoarthritis: a systematic review and meta-analysis. JAMA 320:2564–2579
doi: 10.1001/jama.2018.19319
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX et al (2020) Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 382:1708–1720
doi: 10.1056/NEJMoa2002032
Kaiser R, Svoboda N, Waldauf P, Netuka D (2021) The economic and psychological impact of cancellations of elective spinal surgeries in the Covid-19 era. Br J Neurosurg 18:1–5
doi: 10.1080/02688697.2020.1868404
Kocalevent RD, Hinz A, Brahler E (2013) Standardization of the depression screener patient health questionnaire (PHQ-9) in the general population. Gen Hosp Psychiatry 35:551–555
doi: 10.1016/j.genhosppsych.2013.04.006
Konopka JF, Lee YY, Su EP, McLawhorn AS (2018) Quality-adjusted life years after hip and knee arthroplasty: health-related quality of life after 12,782 joint replacements. JB JS Open Access 3:e0007
doi: 10.2106/JBJS.OA.18.00007
Kort NP, Barrena EG, Bedard M, Donell S, Epinette JA, Gomberg B et al (2020) Recommendations for resuming elective hip and knee arthroplasty in the setting of the SARS-CoV-2 pandemic: the European hip society and European knee associates survey of members. Knee Surg Sports Traumatol Arthrosc 28:2723–2729
doi: 10.1007/s00167-020-06212-0
Kort NP, Barrena EG, Bedard M, Donell S, Epinette JA, Gomberg B et al (2020) Resuming elective hip and knee arthroplasty after the first phase of the SARS-CoV-2 pandemic: the European Hip Society and European Knee Associates recommendations. Knee Surg Sports Traumatol Arthrosc 28:2730–2746
doi: 10.1007/s00167-020-06233-9
Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16:606–613
doi: 10.1046/j.1525-1497.2001.016009606.x
Levis B, Benedetti A, Thombs BD, Collaboration DESD (2019) Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ 365:l1476
doi: 10.1136/bmj.l1476
Liebensteiner MC, Khosravi I, Hirschmann MT, Heuberer PR, Board of the AGASoA, Joint S et al (2020) Massive cutback in orthopaedic healthcare services due to the COVID-19 pandemic. Knee Surg Sports Traumatol Arthrosc 28:1705–1711
doi: 10.1007/s00167-020-06032-2
Lingard EA, Riddle DL (2007) Impact of psychological distress on pain and function following knee arthroplasty. J Bone Joint Surg Am 89:1161–1169
doi: 10.2106/00004623-200706000-00002
MacLaren G, Fisher D, Brodie D (2020) Preparing for the most critically Ill patients with COVID-19: the potential role of extracorporeal membrane oxygenation. JAMA 323:1245–1246
doi: 10.1001/jama.2020.2342
Martin A, Rief W, Klaiberg A, Braehler E (2006) Validity of the brief patient health questionnaire mood scale (PHQ-9) in the general population. Gen Hosp Psychiatry 28:71–77
doi: 10.1016/j.genhosppsych.2005.07.003
Massey PA, McClary K, Zhang AS, Savoie FH, Barton RS (2020) Orthopaedic surgical selection and inpatient paradigms during the coronavirus (COVID-19) pandemic. J Am Acad Orthop Surg 28:436–450
doi: 10.5435/JAAOS-D-20-00360
Mindell JS, Giampaoli S, Goesswald A, Kamtsiuris P, Mann C, Mannisto S et al (2015) Sample selection, recruitment and participation rates in health examination surveys in Europe–experience from seven national surveys. BMC Med Res Methodol 15:78
doi: 10.1186/s12874-015-0072-4
Monstad K, Engesaeter LB, Espehaug B (2014) Waiting time and socioeconomic status–an individual-level analysis. Health Econ 23:446–461
doi: 10.1002/hec.2924
Mouton C, Hirschmann MT, Ollivier M, Seil R, Menetrey J (2020) COVID-19: ESSKA guidelines and recommendations for resuming elective surgery. J Exp Orthop 7:28
doi: 10.1186/s40634-020-00248-4
Nikolova S, Harrison M, Sutton M (2016) The impact of waiting time on health gains from surgery: evidence from a national patient-reported outcome dataset. Health Econ 25:955–968
doi: 10.1002/hec.3195
Nilsdotter AK, Lohmander LS (2002) Age and waiting time as predictors of outcome after total hip replacement for osteoarthritis. Rheumatol (Oxf) 41:1261–1267
doi: 10.1093/rheumatology/41.11.1261
Ostendorf M, Buskens E, van Stel H, Schrijvers A, Marting L, Dhert W et al (2004) Waiting for total hip arthroplasty: avoidable loss in quality time and preventable deterioration. J Arthroplasty 19:302–309
doi: 10.1016/j.arth.2003.09.015
Quon JA, Sobolev BG, Levy AR, Fisher CG, Bishop PB, Kopec JA et al (2013) The effect of waiting time on pain intensity after elective surgical lumbar discectomy. Spine J 13:1736–1748
doi: 10.1016/j.spinee.2013.05.038
Samsson KS, Bernhardsson S, Larsson ME (2017) “Take me seriously and do something!”: a qualitative study exploring patients’ perceptions and expectations of an upcoming orthopaedic consultation. BMC Musculoskelet Disord 18:367
doi: 10.1186/s12891-017-1719-6
Soreide K, Hallet J, Matthews JB, Schnitzbauer AA, Line PD, Lai PBS et al (2020) Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services. Br J Surg 107:1250–1261
doi: 10.1002/bjs.11670
Wang Y, Teichtahl AJ, Abram F, Hussain SM, Pelletier JP, Cicuttini FM et al (2018) Knee pain as a predictor of structural progression over 4 years: data from the osteoarthritis initiative, a prospective cohort study. Arthritis Res Ther 20:250
doi: 10.1186/s13075-018-1751-4
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z et al (2020) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 395:1054–1062
doi: 10.1016/S0140-6736(20)30566-3