Emotional status and fear in patients scheduled for elective surgery during COVID-19 pandemic: a nationwide cross-sectional survey (COVID-SURGERY)
Authors: Montalto Francesca , Ippolito Mariachiara , Noto Alberto , Madotto Fabiana , Gelardi Filippa , Savatteri Paolino , Giarratano Antonino , Cortegiani Andrea ,   the SIAARTI Study Group, Brescia Fabrizio , Fabiani Fabio , Zanier Chiara , Nadalini Elisa , Gambaretti Eros , Gabriele Francesco , Astuto Marinella , Murabito Paolo , Sanfilippo Filippo , Misseri Giovanni , Moscarelli Alessandra , Spadaro Savino , Bussolati Enrico , Squadrani Eleonora , Villa Gianluca , D’Errico Raffaella , Cocci Giulia , Lanini Iacopo , Mirabella Lucia , Morelli Alessandra , Tullo Livio , Caggianelli Girolamo , Ball Lorenzo , Iiriti Margherita , Giordani Francesca , Giardina Massimiliano , Mazzeo Anna Teresa , Grasselli Giacomo , Cattaneo Emanuele , Alongi Salvatore , Marenghi Cristina , Marmiere Marilena , Rocchi Margherita , Turi Stefano , Landoni Giovanni , Torrano Vito , Tinti Giulia , Giorgi Antonio , Fumagalli Roberto , Salvo Francesco , Blangetti Ilaria , Cascella Marco , Forte Cira Antonietta , Navalesi Paolo , Montalbano Marta , Chiarelli Valentina , Bonanno Giuseppe , Ferrara Francesco Paolo , Pernice Innocenza , Catalisano Giulia , Marino Claudia , Presti Gabriele , Fricano Dario Calogero , Fucà Rosa , Palmeri di Villalba Cesira , Strano Maria Teresa , Caruso Sabrina , Scafidi Antonino , Mazzarese Vincenzo , Augugliaro Ettore , Terranova Valeria , Forfori Francesco , Corradi Francesco , Taddei Erika , Isirdi Alessandro , Pratesi Giorgia , Puccini Francesca , Paternoster Gianluca , Barile Alessio , Tescione Marco , Santacaterina Irene , Siclari Eliana Maria , Tripodi Vincenzo Francesco , Vadalà Mariacristina , Agrò Felice Eugenio , Pascarella Giuseppe , Piliego Chiara , Aceto Paola , De Pascale Gennaro , Dottarelli Alessandra , Romanò Bruno , Russo Andrea , Covotta Marco , Giorgerini Valeria , Sardellitti Federica , Vitelli Giulia Maria , Coluzzi Flaminia , Bove Tiziana , Vetrugno Luigi 
Published: November 2021

Abstract
Background
Fragmented data exist on the emotional and psychological distress generated by hospital admission during the pandemic in specific populations of patients, and no data exists on patients scheduled for surgery. The aim of this multicentre nationwide prospective cross-sectional survey was to evaluate the impact of pandemic on emotional status and fear of SARS-CoV-2 contagion in a cohort of elective surgical patients in Italy, scheduled for surgery during the COVID-19 pandemic.

Results
Twenty-nine Italian centres were involved in the study, for a total of 2376 patients surveyed (mean age of 58 years ± 16.61; 49.6% males). The survey consisted of 28 total closed questions, including four study outcome questions. More than half of patients had at least one chronic disease (54%), among which cardiovascular diseases were the commonest (58%). The most frequent type of surgery was abdominal (20%), under general anaesthesia (64%). Almost half of the patients (46%) declared to be frightened of going to the hospital for routine checkups; 55% to be afraid of getting SARS-CoV-2 infection during hospitalization and 62% were feared of being hospitalised without seeing family members. Having an oncological disease and other patient-related, centre-related or perioperative factors were independently associated with an increased risk of fear of SARS-CoV-2 infection during hospitalization and of being hospitalised without seeing family members. A previous infection due to SARS-COV-2 was associated with a reduced risk of worse emotional outcomes and fear of SARS-CoV-2 infection during hospitalization. Patients who showed the most emotionally vulnerable profile (e.g. use of sleep-inducing drugs, higher fear of surgery or anaesthesia) were at higher risk of worse emotional status towards the hospitalization during COVID-19 pandemic. Being operated in hospitals with lower surgical volume and with COVID-19 wards was associated with worse emotional status and fear of contagion.

Conclusions
Additional fear and worse emotional status may be frequent in patients scheduled for elective surgery during COVID-19 pandemic. More than half of the participants to the survey were worried about not being able to receive family visits. Psychological support may be considered for patients at higher risk of psychological distress to improve perioperative wellbeing during the pandemic.