Effect of the COVID-19 Pandemic on Ectopic Pregnancy Outcomes

Study Objective The purpose of this study was to evaluate the effect of the COVID-19 pandemic on the ectopic pregnancy surgical volume, both ruptured and stable cases, at a New York City high-volume, tertiary-care center. Design A retrospective chart review of 2 years of ectopic pregnancy surgical case volume. The time period evaluated included March 2019-February 2020 prior to the COVID-19 pandemic in New York City followed by March 2020-February 2021 when hospital services shifted to care of such patients. Setting N/A. Patients or Participants All patients who underwent emergent gynecological surgery for ectopic pregnancies were reviewed by weekly and monthly volume over a 2-year period. Further review of ruptured as compared to unruptured cases was performed, with particular interest regarding hemoperitoneum at time of abdominal entry. Interventions N/A. Measurements and Main Results There was no significant difference (t(21) = 0.52, p = 0.612) between the pre-pandemic year March 2019 – February 2020 with a total of 33 ectopic cases (mean monthly volume 2.75, SD = 1.42) as compared to March 2020 – February 2021 total of 37 ectopic cases (mean monthly volume 3.08, SD = 1.73). There was no significant difference (t(22) = 0.56, p = 0.583) regarding ruptured ectopic case volume between 2019-2020 and 2020-2021 (total of 23 and 27, mean monthly volume 1.92 and 2.25 respectively). Finally, for ruptured ectopic cases, the mean estimated hemoperitoneum encountered upon entry into the abdomen (excluding subsequent operative blood loss) was 184.29 cc pre-pandemic and 244.8 cc during the pandemic with no significant difference between the years (t (44) = 1.18, p = 0.244). Conclusion There were no significant differences in ectopic case volume prior and after the COVID-19 pandemic and no significant differences in hemoperitoneum upon abdominal entry, suggesting that the fear of the pandemic was not a deterrent to care for patients needing emergent ectopic surgery.

Patient and Surgical Characteristics Associated with Delay or Cancellation of Elective Gynecologic Surgeries Due to the COVID-19 Pandemic

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.

Theatre ventilation.

INTRODUCTION: Owing to the COVID-19 pandemic, there has been significant disruption to all surgical specialties. In the UK, units have cancelled elective surgery and a decrease in aerosol generating procedures (AGPs) was favoured. Centres around the world advocate the use of negative pressure environments for AGPs in reducing the spread of infectious airborne particles. We present an overview of operating theatre ventilation systems and the respective evidence with relation to surgical site infection (SSI) and airborne pathogen transmission in light of COVID-19. METHODS: A literature search was conducted using the PubMed, Cochrane Library and MEDLINE databases. Search terms included "COVID-19", "theatre ventilation", "laminar", "turbulent" and "negative pressure". FINDINGS: Evidence for laminar flow ventilation in reducing the rate of SSI in orthopaedic surgery is widely documented. There is little evidence to support its use in general surgery. Following previous viral outbreaks, some centres have introduced negative pressure ventilation in an attempt to decrease exposure of airborne pathogens to staff and surrounding areas. This has again been suggested during the COVID-19 pandemic. A limited number of studies show some positive results for the use of negative pressure ventilation systems and reduction in spread of pathogens; however, cost, accessibility and duration of conversion remain an unexplored issue. Overall, there is insufficient evidence to advocate large scale conversion at this time. Nevertheless, it may be useful for each centre to have its own negative pressure room available for AGPs and high risk patients.

Survey on Postponement of Benign Gynecologic Surgery during the COVID-19 Pandemic

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.

Essential Gynecologic Surgery during the COVID-19 Pandemic: New York Institutional Experience

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.