Did surgical delay due to COVD-19 affect the short- and longer-term mental health of patients?

OBJECTIVES: At the height of the COVID-19 pandemic, the US Surgeon General ordered the cessation of all elective surgical procedures. We evaluated the mental health impact of COVID-19 related surgical delay on patients awaiting procedures for benign, pre-malignant and malignant conditions. We sought to understand the short term impact of surgical delay and to identify potential longer term mental health affects after completion of the delayed procedure. METHODS: All patients over age 18 awaiting surgery for benign, pre-malignant or malignant conditions in the gynecologic oncology, surgical oncology and colorectal services at Northwell Health were eligible. Upon enrollment, participants completed a baseline survey consisting of the Generalized Anxiety Disorder Questionnaire (GAD-7), the Penn State Worry Questionnaire (PSWQ), and Brief-Illness Patient Questionnaire (B-IPQ). Six weeks after their surgery, participants were sent a second survey consisting of the Center for Epidemiologic Studies Depression (CES-D) scale in addition to the GAD-7, PSWQ, and B-IPQ. RESULTS: 56 patients underwent their procedure and completed the follow-up survey. Patients with suspected benign conditions had a longer delay in scheduling their surgery than patients with suspected/confirmed cancer or pre-malignant conditions (101.4d vs 66.3d, p<0.05). There was no correlation of length of delay with postoperative worry, anxiety, or depression scores. There was no decrease in level of worry, as delineated by the PSWQ, among gynecologic oncology patients when comparing pre-operative to post-operative data. However, surgical oncology and colorectal patients demonstrated decreased post-operative worry. There was no difference in anxiety by surgical specialty.While the surgical delay was ongoing 79% of patients considered it to be moderately to extremely concerning, with 46% indicating the highest possible level of concern. Post-operatively, 47% of the respondents indicated moderate to extreme concern about the surgical delay, while 37% were not concerned. Initially, the surgical delay was considered to have a moderate to severe impact upon daily life by 65% of patients; which decreased to 53% at the time of post-operative follow-up. Interestingly, these relative decreases in patient concern were not significant when comparing pre-operative to post-operative values as a whole, by diagnosis or by specialty. 20% of participants qualified as depressed based on their response to the CES-D. Of these patients, 70% had a post-operatively confirmed cancer or pre-cancer. The incidence of depression was not affected by the post-operative diagnosis. CONCLUSIONS: Many patients experienced distress surrounding surgical delay due to the COVID-19 pandemic. This extended to their postoperative period. Gynecologic oncology patients did not experience decreased post-operative worry, while surgical oncology and colorectal patients did. There was no significant difference in the incidence of post-operative depression by specialty or post-operative diagnosis.