Impact of COVID-19 on Outcomes and Productivity in a Gynecologic Oncology and Minimally Invasive Surgery Practice

STUDY OBJECTIVE: To determine the impact of COVID-19 on patients undergoing surgery. DESIGN: Retrospective review. SETTING: Community hospital and ambulatory practice in New York near the epicenter of the COVID-19 pandemic. PATIENTS OR PARTICIPANTS: Surgical volumes were reviewed for years 2019-2020. INTERVENTIONS: Seventy-three charts were assessed for COVID-19 related outcomes during a 14-week period, beginning February 17(th), 2020. MEASUREMENTS AND MAIN RESULTS: During the study period, gynecologic oncology and minimally invasive surgery activity decreased by 50%. This resulted in economic and clinical disruption. Other surgical divisions showed similar case decreases (34 – 64%) except for otolaryngology which increased by 48%. Seventy-one surgeries were completed in our practice during the study period. Elective cases were restricted on March 7th. Afterward, indications for surgery were malignancy (43.2%), rule out malignancy (27.0%), heavy bleeding (21.6%), and pain (8.1%). All patients were asymptomatic for COVID-19 associated symptoms during preoperative evaluations. Mandatory day-of-surgery COVID-19 PCR testing commenced on April 6th. Prior to this, 49 surgeries were completed. Afterward, 4 of the remaining 21 cases (18%) were cancelled due to positive testing. Of these, 3 tested positive on day of surgery, 1 self-tested positive due to community exposure. All 4 patients remained asymptomatic. Of the 71 patients, 83% were discharged on the same day or on postoperative day one (POD). Postoperatively, 6 patients reported mild COVID-19 symptoms (cough, fever, shortness of breath). Of these, 1 patient tested negative and 5 were not tested. Additionally, 1 patient tested positive remote from surgery (POD #30). Surgeons tested negative for COVID-19 antibodies, and all office staff were asymptomatic. CONCLUSION: Asymptomatic COVID-19 patients were encountered in the preoperative setting. No symptomatic cases of nosocomial COVID-19 infection were identified. Clinical care and surgery appear safe provided there is appropriate utilization of personal protective equipment (PPE). Gynecologic surgical services may be safely performed during a pandemic with appropriate PPE and safety measures.