ABSTRACT
Introduction: The COVID-19 pandemic has had a considerable and evolving impact on delivery of surgical care to patients. During the early stages of the pandemic, resource scarcity was experienced by many healthcare systems. This led to the implementation of a surgical moratorium on elective surgeries in New York State between the months of March through June 2020. Certain specialties, specifically those performing elective surgeries, experienced significant strain and transformation. Objective: This study aims to describe perioperative and intraoperative characteristics of patients undergoing hysterectomy for pelvic organ prolapse (POP) with and without concomitant urogynecology procedures between 2019-2021 at a multi-hospital healthcare system that experienced significantly strain and a subsequent moratorium on elective surgery during the first peak of the pandemic. Methods: This is a retrospective cohort analysis of all patients in a multi-hospital healthcare system in New York City who underwent hysterectomy for POP from August 19th, 2019 through August 11th, 2021. Cases were identified using procedural and diagnostic codes for hysterectomy and POP, respectively. Patients were separated into three cohorts based on dates corresponding to phases of the COVID-19 pandemic. The 'early peak' was defined from March through June 2020, coinciding with the New York State moratorium. The primary outcome was the stage of POP for patients undergoing surgery. Secondary outcomes included concomitant urogynecologic procedures, route of surgery, time from indication to procedure, length of inpatient stay, and utilization of pre-operative medical assessment/clearance (POMA). Results: A total of 253 cases were included: 106 (41.90%), 15 (5.93%), and 132 (52.17%) patients in the 'pre-pandemic','early peak pandemic', and 'stable pandemic' groups, respectively. Although not statistically significant, vaginal hysterectomy approach was performed less frequently during the 'early peak pandemic' and 'stable pandemic' cohorts (P = 0.0544). The 'early peak pandemic' cohort had significantly more stage IV POP compared to other cohorts (P = 0.0021). Rates of concomitant urogynecology procedures including slings, anterior or posterior repair, or apical repair did not differ between the cohorts. Further, cystoscopy was utilized intraoperatively more frequently in the 'stable pandemic' cohort (P = 0.0272). Time from surgical indication to operation was also significantly different with patients most frequently waiting at least 3 months in the 'early peak pandemic' group (P = 0.0132). Length of inpatient stay did not demonstrate a significant difference (P = 0.3982). The most frequent postoperative complication was transient voiding dysfunction, and this was observed more commonly in the 'stable pandemic' cohort (P = 0.0236), though overall no cases were complicated by persistent voiding dysfunction or urinary retention requiring surgical intervention in any group. Conclusions: In late spring 2020, when the moratorium was lifted, surgical volume returned to pre-peak numbers. However, time from booking to day of surgery remained significantly longer during and after the 'peak'. There was a statistically significant increase in patients with stage IV POP during the 'early peak' and 'stable' pandemic periods. There was a statistically significant increase in use of precautionary measures peri and intra-operatively during the 'peak' and 'stable pandemic' periods with significant increases in use of POMA performed outpatient by anesthesia and an increased utilization of intraoperative cystoscopy.
ABSTRACT
Study Objective This study aims to identify patient characteristics associated with length of delay or not returning for elective benign gynecologic surgical procedures that were canceled due to the COVID-19 pandemic. Design Retrospective review of electronic medical records. Setting Academic, urban, tertiary hospital system. Patients or Participants Between March 15, 2020, and May 15, 2020, all elective surgical procedures were canceled due to resource limitations. Electronic medical records were reviewed through November 15, 2020, to assess whether patients rescheduled or did not come back for surgery within the following six-month period. Interventions N/A. Measurements and Main Results 219 benign gynecologic surgeries were canceled between March 15 and May 15, 2020. 158 (72%) patients returned within the following six months for their procedure, and 61 patients (28%) did not return. Among patients who rescheduled, the length of delay was not correlated with age, race/ethnicity, or route of surgery. There was, however, sufficient data to conclude that length of delay differed by primary indication of surgery (p=.0173). There was an association between not returning for surgery and primary indication of pelvic organ prolapse/ incontinence repair (p=.0203). Conclusion The majority of patients rescheduled their procedure within six months following the peak of the COVID-19 crisis. The primary indication of pelvic organ prolapse and incontinence was associated with a decreased likelihood of returning for surgery within six months.
ABSTRACT
Study Objective To assess anxiety, satisfaction with interim medical care, and changes in medical status in patients who had benign gynecologic surgery postponed due to COVID. Design Online patient survey. Setting New York City Academic Medical Center. Patients or Participants In Mid-March of 2020 there was a moratorium on elective services due to the COVID-19 pandemic. In our institution, 220 patients were identified who had gynecologic surgery postponed. Of these patients, 150 patients were successfully contacted and invited to participate in the study, and 86 completed the survey. Interventions The research instrument was an online survey, which included a validated anxiety questionnaire. Measurements and Main Results Indications for surgery were fibroids (48%), abnormal bleeding (16%), ovarian mass (16%), endometriosis (12%), incontinence (8%), infertility (7%), prolapse (5%), and dysplasia (2%). On the Zung Self-Rated Anxiety Scale, 92% scored within normal range and 8% scored mild-to-moderate anxiety level. 50% of patients reported feeling more anxious about COVID exposure, 22% were more anxious about waiting for surgery, and 28% were equally anxious about both. Sentiment analysis of an open-ended question about postponement revealed 52% of responses were negative, 27% neutral, and 21% positive. Primary themes within negative responses were “frustrated” or “disappointed” about surgery cancellation. Primary themes within positive responses were “safe” or “relieved.” During the postponement, 60% of patients reported symptoms were the same, 27% worse, and 13% better. 36% of patients reported using alternative therapy while awaiting surgery, the most common being non-opioid pain medication (37%), hormonal therapy (29%), dietary changes (29%), supplements (20%), bladder training exercises (7%), pessary (2%), and pelvic floor physical therapy (2%). 80% reported access to MyChart, and 30% participated in telehealth visits, of which all reported satisfaction with the visit. Conclusion Patients with benign gynecologic surgery postponed due to COVID-19 had a negative impression of this impact on their care.
ABSTRACT
Study Objective To report on the continuance of gynecologic surgery during the COVID-19 pandemic. Design Case series. Setting New York City Academic Medical Center. Patients or Participants In Mid-March of 2020 there was a moratorium on elective services due to the COVID-19 pandemic. 105 surgeries were completed from March 15-April 30, and those that were emergent and urgent were identified. Essential gynecologic surgical procedures were provided during the COVID-19 pandemic. Interventions Peri-operative data were collected retrospectively. Measurements and Main Results A total of 45 cases were identified that were emergent and urgent gynecologic surgical procedures during the COVID-19 pandemic in New York City. Average age was 34 years (range 24-68). In our health system, there were 23 emergency gynecologic cases, the most common were ectopic (14), torsion (3), retained products of conception causing hemorrhage (3) or sepsis (1), exploratory laparotomy for post-operative small bowel obstruction (1), and vaginal myomectomy for hemorrhage (1). Pre-operative PCR testing for COVID-19 was available March 31, but emergency cases were not delayed to await test results. Of the emergency cases, 21 (91.3%) were performed with general and 2 (8.7%) with neuraxial anesthesia. There were 21 urgent gynecologic surgical procedures. All surgical procedures recovered in the operating room during this time frame. Conclusion Essential gynecologic surgery can feasibly continue during peak pandemic crisis in high prevalence areas, with appropriate safety measures.