Assessment of level of fear in adult patients undergoing elective urogynecologic and gynecologic procedures and surgeries during the COVID-19 pandemic using the validated surgical fear questionnaire (SFQ)

ABSTRACT

Objective: To assess and trend fears surrounding elective surgeries and office procedures with a standardized questionnaire in benign gynecologic and urogynecologic patients during the Coronavirus-19 (COVID) pandemic.We hypothesized that COVID-related fear was greater in surgical patients over procedural patients, that surgical fearwould be greater than historic data, and that fear levels would increase with the course of the pandemic. Methods: This is a multicenter, prospective, observational study. Recruitment occurred from June 23, 2020 until March 23, 2021. Females 18 years or older presenting for elective, benign gynecologic or urogynecologic surgery or office procedures were eligible. Patients were excluded if non-English speaking or undergoing an emergent procedure or surgery. Fear was assessed with the Surgical Fear Questionnaire (SFQ), a validated 8-item survey that evaluates short term (questions 1-4) and long term (questions 5-8) fears related to surgery. We modified the SFQ to include 2-4 additional questions about the COVID-19 pandemic (mSFQ) and to apply to procedures (10 questions) and surgeries (14 questions) (Table 1). Questions were scored on a scale of 0-10 with 0 being 'not at all afraid' and 10 being 'very afraid'. Total SFQ scores and short and long term fear scores were compared between procedures and surgeries and to historic data (Theunissen et al, 2016). Results: 209 subjects undergoing 107 procedures or 102 surgeries completed the questionnaire. Demographics are shown in Table 1. The prevalence of chronic pain, depression, and anxiety was similar to national statistics. The most common procedure was urodynamics (n = 59, 55%). Themost common elective surgery was hysterectomy (n = 59, 57.8%). 72.5% surgeries were for urogynecologic indications. Fear assessed by the SFQ (12.21 ± 16.21) was overall low and not different in subjects undergoing procedures versus surgery (12.38 ± 12.44 vs 12.03 ± 16.01, P = 0.958). Similarly, fear was not different between procedures vs surgery for short term (6.21 ± 8.38 vs 6.81 ± 8.44, P = 0.726) and long term fear (6.18 ± 8.89 vs 5.22 ± 8.20, P = 0.683). The mSFQ, which captured COVID-specific fears, demonstrated higher fear scores for both procedures and surgeries compared to SFQ (mSFQ 20.57 ± 20.55 for procedures, 28.78 ± 28.51 for surgeries versus 12.21 ± 16.21 for SFQ). These included fear of hospitalization, overworked doctors, concern for family, etc (Table 1). There were no significant fluctuations in SFQ score in relation to critical COVID-19 events (Figure 1). We compared our data to the largest study of surgical fear in 428 women undergoing benign hysterectomy outside of a pandemic by Theunissen et al 2016 and found a significantly lower fear in our population in both the short (6.5 ± 8.39 vs 16 ± 9.9, P < 0.001) and long term(5.71 ± 8.56 vs 9.3 ± 8.6, p < 0.001) scores. This lower level of surgical fear persisted solely comparing our hysterectomy subjects to the aforementioned data in both short term (7.37 ± 8.62 vs 16 ± 9.9, p < 0.001) and long term (5.12 ± 7.14 vs 9.3 ± 8.6, P < 0.001) scores. Conclusions: Fear of surgeries and office procedures was overall low and consistent throughout the COVID-19 pandemic. Compared to historic data, our patients had lower levels of surgical fear. Fear scores increased with the addition of COVID-specific questions, indicating some fear surrounding having a procedure or surgery during the pandemic. Interpretation of our results is limited by the fact that the patients surveyed had already decided to continue in-person care.