Study Objective To determine the incidence of perioperative COVID-19 in women undergoing benign gynecologic surgery, and to evaluate perioperative complication rates in patients with active, prior or no prior SARS-CoV-2 infection. Design Multicenter prospective cohort study Setting Ten institutions in the United States Patients Patients over the age of 18 years who underwent benign gynecologic surgery from July 1, 2020 to December 31, 2020 were included. All patients were followed from the time of surgery until 10 weeks post-operatively. Those with intra-uterine pregnancy or known gynecologic malignancy were excluded. Interventions Benign gynecologic surgery Measurements The primary outcome was the incidence of perioperative COVID-19 infections which was stratified as 1) prior COVID-19 infection, 2) pre-operative COVID-19 infection and 3) post-operative COVID-19 infection. Secondary outcomes included adverse events and mortality following surgery, as well as predictors for post-operative COVID-19 infection. If surgery was delayed due to the COVID-19 pandemic, the reason for postponement and any subsequent adverse event was recorded. Main Results 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) were due to a history of COVID-19. The majority (182 [96.3%]) had no sequelae attributed to surgical postponement. Following hospital discharge to 10 weeks post-operatively, 39 (1.1%) patients became infected with SARS-CoV-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 post-operative 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 (adjOR 6.8) and single-unit increase in age-adjusted Charlson co-morbidity index (adjOR 1.2) increased the odds of post-operative COVID-19 infection. Peri-operative complications were not significantly higher in patients with a history of prior positive COVID-19 compared to those without a history of COVID-19, though the mean duration of time between prior COVID-19 diagnosis and surgery was 97 days (14 weeks). Conclusion In this large multi-center prospective cohort study of benign gynecologic surgeries, only 1.1% of patients developed a post-operative COVID-19 infection, with 0.3% of infection in the immediate 14-days after surgery. The incidence of post-operative complications was not different in those with and without prior COVID-19 infections.

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.

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.

Purpose of review Quality improvement and patient safety are relevant to the advancement of clinical care, particularly in the field of minimally invasive gynecologic surgery (MIGS). Although safety and feasibility of MIGS have been established, identification of quality metrics in this field is also necessary. Recent findings Surgical quality improvement has focused on national overarching measures to reduce mortality, surgical site infections (SSIs), and complications. Quality improvement in minimally invasive surgery has additionally led to advancements in postoperative patient recovery and long-term outcomes. Process measures in minimally invasive surgery include use of bundles and enhanced recovery after surgery (ERAS) programs. However, procedure-specific quality metrics for MIGS outcomes are poorly defined at this time. Summary Quality metrics in minimally invasive gynecology are well defined for structural measures and select process measures. Creation of relevant benchmarks for outcome measures in minimally invasive gynecologic surgery are needed.

Table 2). Additionally, increasing age, multiple procedures (>4), abdominal (as opposed to vulvovaginal) approaches, and regional anesthesia were associated with increased odds of being under-scheduled. CONCLUSION: When adjusted for major comorbidities and different anesthesia methods that may affect operating room time, increased BMI is associated with higher odds of a surgery exceeding its allotted operating room time, as determined by the operating surgeon. Gynecologic surgeons may underestimate the additional time required in the operating room by obese patients.