key: cord-0929154-dcq1zqsz
authors: Elsahy, D. A.; Higgins, O. M.; Pickett, C. M.; Kasper, K. M.
title: COVID-19 Delays in Gynecologic Surgery and Their Association with Race, Ethnicity and Insurance Status
date: 2021-11-30
journal: Journal of Minimally Invasive Gynecology
DOI: 10.1016/j.jmig.2021.09.695
sha: 930d01d2125d7e71451ebc3b69e6606a03f684c5
doc_id: 929154
cord_uid: dcq1zqsz

Study Objective To characterize how surgical delays and cancellations experienced by patients needing gynecologic surgery differed during the coronavirus pandemic compared to pre-pandemic and determine if the delay and cancellation rates varied based on the patient's race, ethnicity or insurance type. Design Retrospective cohort study. Setting Urban, academic, tertiary care medical center. Patients or Participants Women aged >18 years who underwent surgery for benign or malignant gynecologic conditions. Interventions None. Measurements and Main Results Pre-COVID included surgeries performed between 3/2019-2/2020 and COVID included surgeries between 3/2020-2/2021. In the pre-COVID group, 1107 cases had no surgical delay (75.3%), 364 cases had surgical delay or cancellation (24.7%). In the COVD group, 1042 cases had no surgical delay (75.5%), 339 cases had surgical delay or cancellation (24.5%). Of delayed surgeries, there was a significant difference in the median number of days to surgery in the COVID-19 group of 31.2 days (13.9-56.0) as compared to the pre-COVID group 14.0 days (7.0-34.8) (p<0.01). Among cases scheduled during the COVID-19 pandemic, after controlling for the urgency of the case, there was no significant association between insurance type, race or ethnicity and the likelihood of having surgery delayed or canceled (OR 0.82,CI 0.64-1.05,p=0.12; OR 0.97,CI 0.73-1.29,p=0.34; OR 1.08,CI 0.58-2.20,p=0.81). Regardless of insurance, race or ethnicity, elective cases during COVID-19 were more likely to be delayed or canceled compared to urgent or emergent cases (OR 1.68, CI 1.07-2.63, p=0.03; OR 1.66, CI 1.06-2.60, p=0.03, OR 1.71, CI 1.08-2.70, p=0.02). Conclusion At a single academic center, while COVID was associated with increased length of surgical delays, case urgency seemed to play a more important role than insurance status, race, and ethnicity in predicting which patients would have their case delayed. The surgical field has documented disparities for decades and it is incredibly important to continue to challenge our role in patient's access to care, especially during the COVID-19 pandemic.

Measurements and Main Results: Pre-COVID included surgeries performed between 3/2019-2/2020 and COVID included surgeries between 3/ 2020-2/2021. In the pre-COVID group, 1107 cases had no surgical delay (75.3%), 364 cases had surgical delay or cancellation (24.7%). In the COVD group, 1042 cases had no surgical delay (75.5%), 339 cases had surgical delay or cancellation (24.5%). Of delayed surgeries, there was a significant difference in the median number of days to surgery in the COVID-19 group of 31.2 days (13.9-56.0) as compared to the pre-COVID group 14.0 days (7.0-34.8) (p<0.01). Among cases scheduled during the COVID-19 pandemic, after controlling for the urgency of the case, there was no significant association between insurance type, race or ethnicity and the likelihood of having surgery delayed or canceled (OR 0.82,CI 0.64-1.05,p=0.12; OR 0.97,CI 0.73-1.29,p=0.34; OR 1.08,CI 0.58-2.20, p=0.81). Regardless of insurance, race or ethnicity, elective cases during COVID-19 were more likely to be delayed or canceled compared to urgent or emergent cases (OR 1.68, CI 1.07-2.63, p=0.03; OR 1.66, CI 1.06-2.60, p=0.03, OR 1.71, CI 1.08-2.70, p=0.02). Conclusion: At a single academic center, while COVID was associated with increased length of surgical delays, case urgency seemed to play a more important role than insurance status, race, and ethnicity in predicting which patients would have their case delayed. The surgical field has documented disparities for decades and it is incredibly important to continue to challenge our role in patient's access to care, especially during the COVID-19 pandemic. Measurements and Main Results: Ultrasound evaluation and surgical management of CS scar pregnancy. Conclusion: Cesarean scar pregnancies can present a challenge to treating physician. Through careful evaluation by minimal tools such as ultrasound, proper diagnosis and appropriate surgical planning can be performed. Ultimately, this will positively impact patient's future fertility and or pregnancy desires.

Case Report: Complication after Laparoscopic Hysterectomy and Sacral Colpopexy Silva KP.,* Kikuchi Fernandes C.F., Cordeiro Ruano J.M., Sr. Gynecology, Federal University of São Paulo, São Paulo, Brazil *Corresponding author.

Study Objective: Illustrate the rare complication after sacral colpopexy surgery to improve knowledge. Design:

Step-by-step description of the surgical procedure using an educational video. Setting: Sacral colpopexy is a classic procedure used for the surgical treatment of pelvic organ prolapse. Nowadays this procedure is better to performed with laparoscopy 1 . Although the procedure boasts excellent success rates, there are risks of complications and reoperation may be required. 2 Probably elderly women have a higher rate of major complication. 3 Patients or Participants: One patient. Interventions: Female patient, 63 years old, had uterine prolapse, stage III (POP-Q system) in the physical exam. Firstly, the hysterectomy was executed and secondly, the colpopexy surgery. The polypropylene net was fixed in the promontory of the sacrum, in the cervix of uterus and vagina. Later, the peritoneum was closed. In the post-operative first day, the patient presented with symptons of intestinal obstruction, confirmed by tomography. The emergency laparoscopy was recommended. In the laparoscopy, it was observed that part of the intestine was incarcerated in the small peritoneum space and formed an hernia. The peritoneum was opened and the intestine was released, after that the peritoneum was closed one more time. The patient evolved well in the post-operative period. Measurements and Main Results: N/A. Conclusion: It is important to be careful with possible post-surgical complications. Keywords: uterine prolapse, sacral colpopexy, laparoscopic surgery complications.

Laparoscopic uterosacral ligament suspension and sacral colpopexy: results and complications

Sacral colpopexy: long-term mesh complications requiring reoperation(s)

Intra-, peri-and postoperative complications in pelvic organ prolapse surgery in geriatric

Abstracts / Journal of Minimally Invasive Gynecology 28 (2021) S81−S160