Impact of Cancellation of Non-urgent Surgical Cases on Patients During the COVID-19 Pandemic

This study is a cross-sectional survey of patients who were scheduled for elective surgical
procedures and their surgeries were cancelled or postponed during the first wave of COVID-19
pandemic. The survey consists of a semi-structured questionnaire that is provided in the
English language. A subsequent translation in patients' own Language will be provided based
on geographical distribution. The survey will be conducted online, via email, or via
telephone call based on the available and best method of participation according to involved
hospital. Participants will be aware of the nature of the study and informed that their
participation will be voluntary. Collected data will be confidential and anonymous.

The questionnaire is developed based on a literature review and clinical experience. Initial
testing of the questionnaire will be performed with 20 patients to assess the reliability and
inter-rater variations. Ambiguous questions and questions with a high rate of "I do not know"
the answer will be excluded. To ensure high compliance, the questionnaire included the least
possible number of questions. The questionnaire consists of closed questions except for two
open questions that explore patients' suggestions to decrease the insult of cancellation on
his life.

After initial testing, the final questionnaire will be formulated. The first sector of the
questionnaire includes patient demographics and baseline characteristics; the second sector
is regarding patient clinical condition, diagnosis, and scheduled surgery. The following
sector examines the process of delivering the cancellation to the patient and requirements
for re-scheduling. Patients will be classified into satisfied or dissatisfied according to
the responses in this sector. The following sector addresses the course of care after
cancellation and whether the patient conducted the surgery elsewhere or not. The last sector
explores the impact of cancellation on patient health, career, and financial aspects. The
impact of cancellation on patients' life will be classified into negative/positive/neutral
based on the answers to this sector.

Statistical analyses will be performed using SPSS v. 20. Data distribution will be tested for
normality using the Kolmogorov-Smirnov test and the Shapiro-Wilk test. Categorical variables
will be expressed as group percentages and will be compared for independent samples using the
Chi-square test. Continuous data of the survey will be presented as medians with ranges or
means and standard deviations. A comparison of continuous data will be compared for
independent samples using the T-test or Mann-Whitney test according to the data distribution.
Spearman correlation coefficient will be used for further assessment of the strength of the
association between variables. The statistical significance level will be set at <0.05.