Surgical Outcomes in Benign Gynecologic Surgery Patients during the COVID-19 Pandemic (SOCOVID study)

• Authors: Rosanne M. Kho, Cleveland Clinic; Olivia H. Chang, Cleveland Clinic; Adam Hare, University of Texas Southwestern; Joseph Schaffer, University of Texas Southwestern; Jen Hamner, Indiana University; Gina Northington, Emory University; Nina Durchfort Metcalfe, Emory University; Cheryl B. Iglesia, MedStar Washington Hospital Center; Anna S. Zelivianskaia, MedStar Washington Hospital Center; Hye-Chun Hur, Columbia University; Sierra Seaman, Columbia University; Margaret G. Mueller, Northwestern Memorial Hospital; Magdy Milad, Northwestern Memorial Hospital; Charles Ascher-Walsh, Mt Sinai Hospital; Kelsey Kossl, Mt Sinai Hospital; Charles Rardin, Women & Infants Hospital Rhode Island; Moiuri Siddique, Women & Infants Hospital Rhode Island; Miles Murphy, Institute for Female Pelvic Medicine; Michael Heit, Emory University
• Journal Title: JOURNAL OF MINIMALLY INVASIVE GYNECOLOGY
• Volume: Volume 29, Number 2
• Publisher: ELSEVIER SCIENCE INC | 2022-02-01, Pages 274-+
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.jmig.2021.08.011
• Subjects: Biology, Virology; Health Sciences, Obstetrics and Gynecology; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Obstetrics & Gynecology; COVID-19; SARS-CoV-2; Gynecologic surgery; Surgical outcomes; Adverse events; Nosocomial infections; SAME-DAY DISCHARGE; READMISSION

Abstract

Study Objective: To determine the incidence of perioperative coronavirus disease (COVID-19) in women undergoing benign gynecologic surgery and to evaluate perioperative complication rates in patients with active, previous, or no previous severe acute respiratory syndrome coronavirus 2 infection. Design: A multicenter prospective cohort study. Setting: Ten institutions in the United States. Patients: Patients aged >18 years who underwent benign gynecologic surgery from July 1, 2020, to December 31, 2020, were included. All patients were followed up from the time of surgery to 10 weeks postoperatively. Those with intrauterine pregnancy or known gynecologic malignancy were excluded. Interventions: Benign gynecologic surgery. Measurements and Main Results: The primary outcome was the incidence of perioperative COVID-19 infections, which was stratified as (1) previous COVID-19 infection, (2) preoperative COVID-19 infection, and (3) postoperative COVID-19 infection. Secondary outcomes included adverse events and mortality after surgery and predictors for postoperative COVID-19 infection. If surgery was delayed because of the COVID-19 pandemic, the reason for postponement and any subsequent adverse event was recorded. Of 3423 patients included for final analysis, 189 (5.5%) postponed their gynecologic surgery during the pandemic. Forty-three patients (1.3% of total cases) had a history of COVID-19. The majority (182, 96.3%) had no sequelae attributed to surgical postponement. After hospital discharge to 10 weeks postoperatively, 39 patients (1.1%) became infected with severe acute respiratory syndrome coronavirus 2. The mean duration of time between hospital discharge and the follow-up positive COVID-19 test was 22.1 ± 12.3 days (range, 4–50 days). Eleven (31.4% of postoperative COVID-19 infections, 0.3% of total cases) of the newly diagnosed COVID-19 infections occurred within 14 days of hospital discharge. On multivariable logistic regression, living in the Southwest (adjusted odds ratio, 6.8) and single-unit increase in age-adjusted Charlson comorbidity index (adjusted odds ratio, 1.2) increased the odds of postoperative COVID-19 infection. Perioperative complications were not significantly higher in patients with a history of positive COVID-19 than those without a history of COVID-19, although the mean duration of time between previous COVID-19 diagnosis and surgery was 97 days (14 weeks). Conclusion: In this large multicenter prospective cohort study of benign gynecologic surgeries, only 1.1% of patients developed a postoperative COVID-19 infection, with 0.3% of infection in the immediate 14 days after surgery. The incidence of postoperative complications was not different in those with and without previous COVID-19 infections.