Insights into patient preferences for elective surgery during the COVID-19 pandemic
Andrew James Hotchen, MRCS, Academic Clinical Fellow, Trauma and Orthopaedic Surgery, 1 , 2 Saad A. Khan, BA (Cantab), Medical Student, 3 Maaz A. Khan, BA (Cantab), Medical Student, 3 Matthew Seah, MRCS, Academic Clinical Fellow, Trauma and Orthopaedic Surgery, 1 , 2 Zain H. Charface, BA (Cantab), Medical Student, 3 Zarif Khan, BA (Cantab), Medical Student, 3 Wasim Khan, FRCS (T&O), PhD, University Lecturer and Honorary Consultant, Trauma and Orthopaedic Surgeon, 1 , 2 Niel Kang, FRCS (T&O), MD, Consultant Trauma and Orthopaedic Surgeon, Associate Lecturer, 2 Joel Thomas Kirk Melton, FRCS (T&O), MD, Consultant Trauma and Orthopaedic Surgeon, Associate Lecturer, 2 Andrew W. McCaskie, FRCS (T&O), MD, Professor of Trauma and Orthopaedic Surgery, Head of Department, Honorary Consultant Trauma and Orthopaedic Surgeon, 1 , 2 and Stephen M. McDonnell, FRCS (T&O), MD, Lecturer, Honorary Consultant Trauma and Orthopaedic Surgeon 1 , 2Hip Knee
Aims
To investigate factors that contribute to patient decisions regarding attendance for arthroplasty during the COVID-19 pandemic.
Methods
A postal questionnaire was distributed to patients on the waiting list for hip or knee arthroplasty in a single tertiary centre within the UK. Patient factors that may have influenced the decision to attend for arthroplasty, global quality of life (QoL) (EuroQol five-dimension three-level (EQ-5D-3L)), and joint-specific QoL (Oxford Hip or Knee Score) were assessed. Patients were asked at which ‘COVID-alert’ level they would be willing to attend an NHS and a “COVID-light” hospital for arthroplasty. Independent predictors were assessed using multivariate logistic regression.
Results
Of 540 distributed questionnaires, 400 (74.1%; 236 awaiting hip arthroplasty, 164 awaiting knee arthroplasty) complete responses were received and included. Less than half (48.2%) were willing to attend for hip or knee arthroplasty while a UK COVID-19 epidemic was in circulation (COVID-alert levels 3 to 5). Patients with worse joint-specific QoL had a preference to proceed with surgery at COVID-alert levels 3 to 5 compared to levels 1 and 2 (hip arthroplasty odds ratio (OR) 1.54 (95% confidence interval (CI) 1.45 to 1.63); knee arthroplasty OR 1.16 (1.07 to 1.26)). The odds of patients with worse joint-specific QoL being willing to attend for surgery at COVID-alert levels 3 to 5 increased further if surgery in a private, “COVID-light” hospital was available (hip arthroplasty OR 3.50 (95% CI 3.26 to 3.71); knee arthroplasty OR 1.41 (95% CI 1.29 to 1.53).
Conclusion
Patient decisions surrounding elective surgery have been influenced by the global COVID-19 pandemic, highlighting the importance of patient involvement in ensuring optimized provision of elective surgery during these challenging times.
Cite this article: Bone Jt Open 2021;2(4):261–270.
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