Impact of delay due to the first wave of COVID-19 pandemic on elective surgical patients in a tertiary care center: An observational study.

Abstract

Abstract Background: To cope with the stress on the health care system caused by Coronavirus disease 2019 (COVID-19), elective services were withheld in most parts of the world for a variable duration. However, delaying elective services for more than a particular duration adversely affects outcomes of the underly disease. This study was conducted to assess the outcome on elective surgical patients due to delay due to withholding elective surgical services caused by the first wave of the COVID-19 pandemic at our institute. Methodology: This prospective observational study included all the patients planned and waiting for elective surgery till the day elective services were withheld at our institution (24th March 2020) due to the COVID-19 pandemic. All benign and malignant patients were followed until the patients were operated on or three months until elective operative services were resumed at our institution to determine the proportion of patients with worsening symptoms, stage progression, and needing emergency procedures or palliative surgery.Results: Breast cancer was the most common cancer among malignancy patients awaiting surgery. Compared to breast cancer, gastrointestinal cancers had a significantly higher proportion of patients with stage progression (61.3% vs 90%, p = 0.016) and mortality (6.5% vs 53.3%, p < 0.001). In benign patients, symptom progression was seen in 45.9% and emergency surgery/procedure was needed in 5.4 % of patients.Conclusion: Even though the so-called elective surgery, postponing these surgeries, particularly cancer surgeries, can compromise the outcomes of the patients if delayed for more than a certain point. Hence the decision to postpone an elective surgery should be cautioned, even during pandemics.