In March 2020, when the pandemic hit, everything slowed down, including minor medical procedures such as elective surgery, to reduce the spread of the coronavirus.
Six weeks later, Dr. Mary Byrnes, an assistant researcher in the Department of Surgery at Michigan Medicine, began calling patients at Frankel Cardiovascular Center at the University of Michigan whose surgeries were canceled or delayed. She wanted to hear about their experiences – what the operation meant to them, how the delay in the operation affected them, whether the existence of the coronavirus complicated their feeling towards the bodies and the operation.
For the next 10 days, she heard stories of fear: “I’m literally afraid of being operated on and going to prayer day in and day out hoping … that I have nothing fatal to attack my system.”
And the suffering: “Last week … I just struggled. And I … I don’t know if it’s more symptoms or anxiety or whatever, but … I’m ready to leave this behind and I hope we live a better life . “
Like altruism: “As much as I wanted to, those nurses are overwhelmed right now. They don’t need another person inside. Let’s hope this starts to calm down and they get a breather before … people come in for surgery. “
Together, 47 interviews conducted by Byrnes – compiled for a study recently published in Medical care – illustrate the profound impact of delaying cardiovascular surgery due to the COVID-19 pandemic.
“There’s another paper coming out that says patients don’t really care about postponing their surgeries,” says Byrnes, the study’s first author. “But the heart is another kind of organ that has a lot of emotions around it. It’s even literary.”
Although it was an election operation, it was a serious operation in which people literally had their breasts ruptured, so there was a lot of mental preparation to face it first. Ultimately, they considered the surgery a cure, so it was unknown to them whether that would happen was problematic. “
Dr. Mary Byrnes, Research Assistant, Department of Surgery, Michigan Medicine
Despite their uncertainty, many patients preferred to wait for surgery in an effort to avoid catching COVID-19. Some thought they were likely to die from their cardiovascular conditions before their surgery could take place, but they still favored the death of “the devil they knew” instead of “the devil they didn’t,” Byrnes says.
More Americans have died in the past year than would be expected, even when those who have died from COVID-19 or related complications are taken into account. One of the driving factors may be certain cardiovascular conditions, namely ischemic heart disease – when narrowed coronary arteries cause heart problems – and disease associated with high blood pressure. States that experienced COVID-19 jumps early in the pandemic, including New York and Michigan, also recorded a jump in deaths associated with these problems, potentially because patients avoided health care during those periods.
“Patients suffer even though we don’t see them,” Byrnes says. “We need to think about our policies and the way we talk to patients in terms of the fact that they think they’re going to die – and they could.”
As Michigan medicine and other local health systems begin to delay a small number of surgeries again, thanks to the latest wave of COVID-19 in Michigan, the findings of this study can serve decisions made by hospital management and create opportunities for additional communication and support for cardiovascular patients.
“We need to be upfront and available,” says Nicholas H. Osborne, Ph.D. Med., Assistant Director of Vascular Surgery at Michigan Medicine and the final author of the study. “Cancellations should be communicated directly to patients, and surgeons should be available to talk to patients to reassure them.”
“As a health care system, we may also need to design and implement interventions, such as support systems or social work resources, to minimize the impact these delays have on the well-being of our patients,” says Craig Brown, Ph.D. Med., MS, a resident of general surgery at Michigan Medicine and an additional study author. “It’s not just an inconvenience for many of them, but it has dramatic consequences and significant psychological impacts on their well-being.”
Michigan Medicine – University of Michigan
Byrnes, ME, and others. (2021) Elective surgical delays due to COVID-19 Patient experience. Medical care. doi.org/10.1097/MLR.0000000000001503.