Patient stress due to surgery postponement in a tertiary referral centre transformed to a COVID-19 hospital

Dear Editor At the beginning of 2021, all surgical procedures were cancelled at this institution without foreseeing the health and emotional consequences1. Even though guidelines recommended that cancer surgery should not be cancelled, this was not possible here2. It is estimated that more than 28 404 603 operations were cancelled worldwide, of which one-third were related to malignancy3. The stress caused to patients has not yet been fully characterized so was studied here. Consenting patients whose surgery was cancelled owing to the COVID-19 pandemic between April 2020 and August 2020 were assessed using the Perceived Stress Questionnaire (PSQ) described by Sanz-Carrillo and colleagues4. The institutional ethics committee approved the project. Two intervals were evaluated: general stress, described as a time lap 2 years before the event (before the surgery was cancelled), and recent stress (after the surgery had been cancelled). The mean(s.d.) of the total score obtained for general stress and recent stress were transformed into an index as described by Levenstein and co-workers5. Demographic variables were gathered, and the correlation between sex, age and PSQ score was evaluated by means of the Pearson’s correlation coefficient. The paired t test was used for evaluation of continuous variables and McNemar’s test for categorical variables. Statistical analysis was performed using Stata® release 14 (StataCorp, College Station, TX, USA). A total of 70 patients were included; 33 per cent were male patients, 61 per cent lived in Mexico City, and 40 per cent had a job, whereas 54 per cent were unemployed or retired. Only 28 per cent had a higher degree. Mean(s.d.) age was 53.1(15.2) years and 38 per cent were married. Sixty per cent had a cancer diagnosis. The mean(s.d.) total PSQ score before the event was 0.34(0.09) and that after the event was 0.38(0.11), significantly higher than the pre-event value (P < 0.001). Scores before and after the event did not differ between male or female patients, and did not correlate with age (Table 1). Perceived stress was higher than before cancellation. PSQ scores did not correlate with age or sex, in keeping with the work of others4. Perceived Stress Questionnaire scores in relation to sex and age Values are mean(s.d.). PSQ, Perceived Stress Questionnaire. *Paired t test. This work has revealed the hidden toll that cancellation of surgery had among patients during the more severe months of lockdown. The raised PSQ scores after cancellation may have implications for surgical outcomes not addressed in this work. Further studies should investigate these psychosocial repercussions. Disclosure. The authors declare no conflict of interest.

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