Impact of COVID-19 on Elective Orthopaedic Surgery: Increased Pain and Psychosocial Distress
Overview
The COVID-19 pandemic led to the cancellation and postponement of elective orthopaedic surgeries, resulting in significantly increased pain levels and heightened psychosocial distress among patients. A study of 77 patients showed a rise in mean pain scores and a notable prevalence of depressive symptoms following surgery delays.
Background
In response to the COVID-19 pandemic declared by WHO in March 2020, elective surgeries across Europe were postponed to prioritize COVID-19 patient care. Delays in elective orthopaedic procedures such as total hip or knee arthroplasty are known to worsen preoperative pain and physical function, potentially compromising postoperative outcomes. Additionally, psychosocial distress—including depression and anxiety—negatively impacts recovery and is prevalent in a significant subset of orthopaedic patients. This study hypothesized that COVID-19-related surgery postponements would increase both pain and psychosocial distress.
Data Highlights
Measure
Before Cancellation
After Cancellation
p-value
Mean Pain Level (VAS)
5.5 ± 2.2
6.2 ± 2.5
< 0.0001
Increased Analgesic Use
38% of patients
Response Rate
65% (77/119 patients)
PHQ-9 Cut-off for Psychosocial Distress
≥10 points
PHQ-9 Cut-off for Clinical Depression
≥15 points
Key Findings
Mean pain levels increased significantly from 5.5 to 6.2 on the VAS after surgery postponement (p < 0.0001).
38% of patients reported increased use of analgesics following cancellation.
Female patients had significantly higher pain levels before cancellation (p = 0.029), but no gender difference was seen after cancellation.
Psychosocial distress was assessed using the PHQ-9, with a score ≥10 indicating distress and ≥15 indicating clinically relevant depression.
79% of surgeries were cancelled by the hospital due to governmental restrictions; 16% of patients cancelled themselves due to COVID-19 concerns.
61% of patients indicated willingness to undergo surgery even during the pandemic if possible.
Clinical Implications
Clinicians should be aware that postponement of elective orthopaedic surgeries during the COVID-19 pandemic is associated with increased patient pain and psychosocial distress, which may negatively impact postoperative outcomes. Screening for depressive symptoms using tools like the PHQ-9 can help identify patients at risk and guide supportive interventions. Maintaining communication and considering patient willingness to proceed with surgery during pandemics may help mitigate adverse effects.
Conclusion
The COVID-19-related cancellation of elective orthopaedic surgeries significantly increased pain levels and psychosocial distress among patients, underscoring the importance of addressing both physical and mental health during treatment delays. These findings highlight the need for comprehensive patient management strategies during healthcare disruptions.
References
Kroenke et al. 2001 -- The PHQ-9: Validity of a Brief Depression Severity Measure
Levis et al. 2020 -- Accuracy of PHQ-9 for Screening Major Depression
Ayers et al. -- Psychosocial Distress and Outcomes in Total Knee Arthroplasty
Fielden et al. -- Impact of Waiting Times on Orthopaedic Surgery Outcomes
Chemsex at the pharmacy counter. Gut bacteria tracking helmet impacts. PMD predicting psychiatric illness bidirectionally. This week's research keeps landing in the same uncomfortable place: medicine is improvising.
