key: cord-0942547-us230ufj authors: Keles, Esra; Akis, Serkan; Kemal Ozturk, Ugur; Eser Ozyurek, Sefik; Api, Murat title: Gynecological surgeries during the COVID‐19 pandemic in Turkey date: 2020-07-24 journal: Int J Gynaecol Obstet DOI: 10.1002/ijgo.13292 sha: 15b784f26fe4849430d8c03fc2f9b1f8416b0867 doc_id: 942547 cord_uid: us230ufj Surgery can continue safely during the pandemic in a specialty hospital that does not accept COVID‐19‐positive patients. Surgical attendants were protected with surgical masks, caps, gowns, sterile gloves, and face shields during surgery. The choice of surgical mask type and face shield was subject to the availability of equipment and discretion of the medical staff and surgeons. Only essential personnel remained in the operating room during patient intubation/extubation. Our hospital did not have a negative-pressure operating theater, and a high-efficiency particulate air filter was not available in the operating rooms. During the study period, 1515 surgical procedures were performed. After excluding ambulatory surgical procedures (Fig. 1) , 141 operations remained to be analyzed. We managed to reach 127 (90%) of these patients within 14 postoperative days. Since none of the patients presented with COVID-19 symptoms, reverse transcriptasepolymerase chain reaction (RT-PCR) and antibody testing had not been performed preoperatively. During telephone calls, patients were asked whether they had symptoms including fever or cough, and whether they had a positive COVID-19 test following their surgery. The type of surgery, indications, pathological results, length of stay in intensive care unit and/or hospital, blood transfusions, and data including any symptoms/tests for COVID-19 ( RT-PCR testing, detection of SARS-CoV-2 antibodies, chest CT, etc.) obtained during the telephone conversations are presented in Table 1 . After discharge, fever was reported in three patients (2.4%) and cough in nine patients (7.1%). COVID-19 tests were performed in two of the three patients with fever, and four of the nine patients with cough. In the postoperative period 1.6% (2/127) of all patients tested positive for COVID-19. As the pandemic progressed, we found that the total number of surgeries decreased by 77.9%, and the number of oncologic surgeries decreased by 20% in the last 3 weeks of the study period. However, proportionally speaking, the ratio of malignant cases operated on at our hospital continued to increase in parallel with the increasing incidence of COVID-19 and intensifying precautions ( Table 2 ). The weekly proportion of malignant cases within the total number of major surgical interventions are presented in Figure 2 . Nationwide COVID-19 cases and all data from this study within 6-week time segments are shown in Table 2 . During the COVID-19 outbreak, all health institutions in our country were rearranged to serve patients who were diagnosed with or suspected of having COVID-19 while scheduled elective surgeries were postponed. 4, 7 Since our institution did not accept known or suspected cases of COVID-19, we did not change our strategy in planning for gynecologic oncological surgeries. Therefore, due to additional referrals, we operated on a higher proportion of malignant surgical cases during the 6 week period. The present study found that surgical operations could continue during the COVID-19 pandemic in a specialty hospital (i.e. in a women's and children's diseases hospital) that was not primarily serving as a pandemic hospital. This conclusion could possibly be extended to other specialty hospital settings. The prevalence of COVID-19 in specialty hospitals could be lower than the regional prevalence; therefore, performing surgeries may be safer for both patients and healthcare providers in these specialty clinics. Coronavirus declared pandemic by World Health Organization Covid 19 pandemic and gynaecological laparoscopic surgery: Knowns and unknowns. Facts Views Vis Obgyn What is the appropriate use of laparoscopy over open procedures in the current COVID-19 climate? American Association of Gynecologic Laparoscopists (AAGL) Perspectives on surgery in the time of COVID-19: Safety first Surgery in COVID-19 patients: Operational directives ESGE recommendations on gynaecological endoscopic surgery during Covid-19 outbreak Cancer surgery during the Covid-19 pandemic in Turkey PAinTer eT Al. The authors have no conflicts of interest. institution.