Loh Pui San, Chaw Sook Hui, Foong Yi Xian, Ramasamy Dhurgka, Zaki Rafdzah Ahmad, Kuppusamy Shanggar, Ong Teng Aik, See Mee Hoong, Khor Hui Min
Department of Anaesthesiology, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
Department of Social and Preventive Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
Perioper Med (Lond). 2022 Mar 17;11(1):10. doi: 10.1186/s13741-022-00242-7.
Many institutions withheld elective lists and triaged surgeries during the peak of coronavirus disease 2019 (COVID-19) pandemic. As a result, older surgical patients have had to wait for rescheduled dates in a long waitlist. This study aimed to identify the psychological impact in these patients when they returned for surgery.
This was a cross-sectional study which included 153 patients aged ≥ 65 years undergoing elective surgery. Trained interviewers recruited and assessed psychological status pre-operatively with two validated questionnaires - Hospital Anxiety and Depression Scale (HADS) and 36-item Short Form Health Survey (SF-36). Specific questions were asked about their postponed surgeries, appetite and fear.
A total of 36 out of 153 (23.5%) patients had their procedures deferred during the first wave of COVID-19 pandemic. Postponed cases were significantly based on the nature of surgery (p = 0.002), cancer diagnosis (p = 0.006) and surgical specialty (p = 0.023). Median HADS scores were higher for patients who were postponed (2.00 versus 4.00 for anxiety, p = 0.180 and 0.00 versus 1.00 for depression, p = 0.424) although no statistical significance was shown. In the whole study population, anxiety was a significant predictor for depression and vice versa (p < 0.001) with other predictive risk factors for anxiety that were age ≥ 85 years old (odds ratio [OR] 6.14, p = 0.018), female (OR 2.41, p = 0.024), cancer (OR 2.19, p = 0.039) and major surgery (OR 2.39, p = 0.023). Similarly, older patients ≥ 85 years old (OR 10.44, p = 0.003) and female (OR 6.07, p = 0.006) had higher risk for depression. Both anxiety and depression were significant risks for loss of appetite (p = 0.005 and 0.001). Lastly, the fear of disease progression due to rescheduling was more frequent in cancer patients (p = 0.035).
The mental health and disease burden of older surgical patients should be taken into careful consideration when cases need to be postponed in our healthcare system.
在2019冠状病毒病（COVID-19）大流行高峰期，许多机构暂停了择期手术安排并对手术进行了分类处理。结果，老年外科患者不得不在长长的等候名单中等待重新安排手术日期。本研究旨在确定这些患者再次接受手术时的心理影响。
这是一项横断面研究，纳入了153例年龄≥65岁接受择期手术的患者。经过培训的访谈者在术前使用两份经过验证的问卷——医院焦虑抑郁量表（HADS）和36项简短健康调查问卷（SF-36）招募并评估患者的心理状态。还询问了有关他们推迟手术、食欲和恐惧的具体问题。
在153例患者中，共有36例（23.5%）在COVID-19大流行的第一波期间推迟了手术。推迟的病例在很大程度上取决于手术性质（p = 0.002）、癌症诊断（p = 0.006）和外科专科（p = 0.023）。虽然未显示出统计学意义，但推迟手术患者的HADS中位数得分较高（焦虑得分分别为2.00对4.00，p = 0.180；抑郁得分分别为0.00对1.00，p = 0.424）。在整个研究人群中，焦虑是抑郁的一个重要预测因素，反之亦然（p < 0.001），焦虑的其他预测风险因素包括年龄≥85岁（比值比[OR] 6.14，p = 0.018）、女性（OR 2.41，p = 0.024）、癌症（OR 2.19，p = 0.039）和大手术（OR 2.39，p = 0.023）。同样，年龄≥85岁的老年患者（OR 10.44，p = 0.003）和女性（OR 6.07，p = 0.006）患抑郁症的风险更高。焦虑和抑郁都是食欲不振的重要风险因素（p = 0.005和0.001）。最后，癌症患者因重新安排手术时间而担心疾病进展的情况更为常见（p = 0.035）。
在我们的医疗系统中，当需要推迟手术时，应仔细考虑老年外科患者的心理健康和疾病负担。
