The impact of delaying surgery during the COVID-19 pandemic in Alberta: a qualitative study

Abstract

Background: The COVID-19 pandemic overwhelmed health care systems, leading many jurisdictions to reduce surgeries to create capacity (beds and staff) to care for the surge of patients with COVID-19; little is known about the impact of this on patients whose surgery was delayed. The objective of this study was to understand the patient and family/caregiver perspective of having a surgery delayed during the COVID-19 pandemic.

Methods: Using an interpretative descriptive approach, we conducted interviews between Sept. 20 and Oct. 8, 2021. Adult patients who had their surgery delayed or cancelled during the COVID-19 pandemic in Alberta, Canada, and their family/caregivers were eligible to participate. Trained interviewers conducted semistructured interviews, which were iteratively analyzed by 2 independent reviewers using an inductive approach to thematic content analysis.

Results: We conducted 16 interviews with 15 patients and 1 family member/caregiver, ranging from 27 to 75 years of age, with a variety of surgical procedures delayed. We identified 4 interconnected themes: individual-level impacts on physical and mental health, family and friends, work and quality of life; system-level factors related to health care resources, communication and perceived accountability within the system; unique issues related to COVID-19 (maintaining health and isolation); and uncertainty about health and timing of surgery.

Interpretation: Although the decision to delay nonurgent surgeries was made to manage the strain on health care systems, our study illustrates the consequences of these decisions, which were diffuse and consequential. The findings of this study highlight the need to develop and adopt strategies to mitigate the burden of waiting for surgery during and after the COVID-19 pandemic.

Figure 1:

Four interconnected themes were identified by participants. Participants reported several individual-level effects of delaying surgery during the COVID-19 pandemic, including the impact on family and friends, their mental health, their physical health and work. The individual-level subthemes were interrelated (e.g., the impact on family and friends exacerbated the impact on participants’ mental health). Similarly, there were system-level factors, including communication, accountability and responsibility, and health care provider and health care resources that mediated the individual-level impacts. Uncertainty was a cloud that hung over all of the individual-and system-level impacts. Similarly, the COVID-19 pandemic introduced several unique factors that touched many of the themes and subthemes.