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

Abstract

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.

Joint Recommendations From The Latin American Association of Cardiac and Endovascular Surgery (LACES) and The Cardiovascular Anesthesia Committee of The Latin American Confederation of Anesthesia Societies (CLASA) on the Timing for Cardiac Surgery After COVID-19 Infection

“…Three of them corresponded to prospective articles [ 1 , 7 , 9 ] , and the rest were retrospective [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ] ). Among the prospective studies, the COVID-19Surg [ 1 ] is the largest prospective registry and included all kinds of surgeries.…”

“…The SOCOVID-19 study [ 9 ] is a multicenter prospective registry of patients undergoing gynecological surgery during the pandemic. Of 114 patients with a history of COVID-19, the incidence of serious complications and mortality was similar to those of patients without prior COVID-19.…”

A Decision Support System for the Surgical Care during the Epidemic of Covid-19

“…Kho et al [9] have determined the incidence of perioperative coronavirus. Disease 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 infections.…”

“…To the best of my knowledge, there is no quantitative study in the literature that considers the Covid policies in the whole surgical process. Authors are limited on one stage of the surgical process, as in [9], they have determined the incidence of perioperative coronavirus disease 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 infections.…”

Lumbar fusion during the COVID-19 pandemic: greater rates of morbidity and longer procedures

“…Several studies have evaluated the potential impact of the COVID-19 pandemic on postoperative outcomes following various types of surgical procedures ( 6 - 8 ). However, there is a paucity of literature evaluating the potential changes in surgical outcomes and perioperative factors for spine procedures performed during the pandemic.…”