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COVID-19 Delays in Gynecologic Surgery and Their Association with Race, Ethnicity and Insurance Status

STUDY OBJECTIVE: To characterize how surgical delays and cancellations experienced by patients needing gynecologic surgery differed during the coronavirus pandemic compared to pre-pandemic and determine if the delay and cancellation rates varied based on the patient's race, ethnicity or insuran...

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Autores principales: Elsahy, D.A., Higgins, O.M., Pickett, C.M., Kasper, K.M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Published by Elsevier Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8518351/
http://dx.doi.org/10.1016/j.jmig.2021.09.695
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author Elsahy, D.A.
Higgins, O.M.
Pickett, C.M.
Kasper, K.M.
author_facet Elsahy, D.A.
Higgins, O.M.
Pickett, C.M.
Kasper, K.M.
author_sort Elsahy, D.A.
collection PubMed
description STUDY OBJECTIVE: To characterize how surgical delays and cancellations experienced by patients needing gynecologic surgery differed during the coronavirus pandemic compared to pre-pandemic and determine if the delay and cancellation rates varied based on the patient's race, ethnicity or insurance type. DESIGN: Retrospective cohort study. SETTING: Urban, academic, tertiary care medical center. PATIENTS OR PARTICIPANTS: Women aged >18 years who underwent surgery for benign or malignant gynecologic conditions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Pre-COVID included surgeries performed between 3/2019-2/2020 and COVID included surgeries between 3/2020-2/2021. In the pre-COVID group, 1107 cases had no surgical delay (75.3%), 364 cases had surgical delay or cancellation (24.7%). In the COVD group, 1042 cases had no surgical delay (75.5%), 339 cases had surgical delay or cancellation (24.5%). Of delayed surgeries, there was a significant difference in the median number of days to surgery in the COVID-19 group of 31.2 days (13.9-56.0) as compared to the pre-COVID group 14.0 days (7.0-34.8) (p<0.01). Among cases scheduled during the COVID-19 pandemic, after controlling for the urgency of the case, there was no significant association between insurance type, race or ethnicity and the likelihood of having surgery delayed or canceled (OR 0.82,CI 0.64-1.05,p=0.12; OR 0.97,CI 0.73-1.29,p=0.34; OR 1.08,CI 0.58-2.20,p=0.81). Regardless of insurance, race or ethnicity, elective cases during COVID-19 were more likely to be delayed or canceled compared to urgent or emergent cases (OR 1.68, CI 1.07-2.63, p=0.03; OR 1.66, CI 1.06-2.60, p=0.03, OR 1.71, CI 1.08-2.70, p=0.02). CONCLUSION: At a single academic center, while COVID was associated with increased length of surgical delays, case urgency seemed to play a more important role than insurance status, race, and ethnicity in predicting which patients would have their case delayed. The surgical field has documented disparities for decades and it is incredibly important to continue to challenge our role in patient's access to care, especially during the COVID-19 pandemic.
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spelling pubmed-85183512021-10-15 COVID-19 Delays in Gynecologic Surgery and Their Association with Race, Ethnicity and Insurance Status Elsahy, D.A. Higgins, O.M. Pickett, C.M. Kasper, K.M. J Minim Invasive Gynecol 6637 STUDY OBJECTIVE: To characterize how surgical delays and cancellations experienced by patients needing gynecologic surgery differed during the coronavirus pandemic compared to pre-pandemic and determine if the delay and cancellation rates varied based on the patient's race, ethnicity or insurance type. DESIGN: Retrospective cohort study. SETTING: Urban, academic, tertiary care medical center. PATIENTS OR PARTICIPANTS: Women aged >18 years who underwent surgery for benign or malignant gynecologic conditions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Pre-COVID included surgeries performed between 3/2019-2/2020 and COVID included surgeries between 3/2020-2/2021. In the pre-COVID group, 1107 cases had no surgical delay (75.3%), 364 cases had surgical delay or cancellation (24.7%). In the COVD group, 1042 cases had no surgical delay (75.5%), 339 cases had surgical delay or cancellation (24.5%). Of delayed surgeries, there was a significant difference in the median number of days to surgery in the COVID-19 group of 31.2 days (13.9-56.0) as compared to the pre-COVID group 14.0 days (7.0-34.8) (p<0.01). Among cases scheduled during the COVID-19 pandemic, after controlling for the urgency of the case, there was no significant association between insurance type, race or ethnicity and the likelihood of having surgery delayed or canceled (OR 0.82,CI 0.64-1.05,p=0.12; OR 0.97,CI 0.73-1.29,p=0.34; OR 1.08,CI 0.58-2.20,p=0.81). Regardless of insurance, race or ethnicity, elective cases during COVID-19 were more likely to be delayed or canceled compared to urgent or emergent cases (OR 1.68, CI 1.07-2.63, p=0.03; OR 1.66, CI 1.06-2.60, p=0.03, OR 1.71, CI 1.08-2.70, p=0.02). CONCLUSION: At a single academic center, while COVID was associated with increased length of surgical delays, case urgency seemed to play a more important role than insurance status, race, and ethnicity in predicting which patients would have their case delayed. The surgical field has documented disparities for decades and it is incredibly important to continue to challenge our role in patient's access to care, especially during the COVID-19 pandemic. Published by Elsevier Inc. 2021-11 2021-10-15 /pmc/articles/PMC8518351/ http://dx.doi.org/10.1016/j.jmig.2021.09.695 Text en Copyright © 2021 Published by Elsevier Inc. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle 6637
Elsahy, D.A.
Higgins, O.M.
Pickett, C.M.
Kasper, K.M.
COVID-19 Delays in Gynecologic Surgery and Their Association with Race, Ethnicity and Insurance Status
title COVID-19 Delays in Gynecologic Surgery and Their Association with Race, Ethnicity and Insurance Status
title_full COVID-19 Delays in Gynecologic Surgery and Their Association with Race, Ethnicity and Insurance Status
title_fullStr COVID-19 Delays in Gynecologic Surgery and Their Association with Race, Ethnicity and Insurance Status
title_full_unstemmed COVID-19 Delays in Gynecologic Surgery and Their Association with Race, Ethnicity and Insurance Status
title_short COVID-19 Delays in Gynecologic Surgery and Their Association with Race, Ethnicity and Insurance Status
title_sort covid-19 delays in gynecologic surgery and their association with race, ethnicity and insurance status
topic 6637
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8518351/
http://dx.doi.org/10.1016/j.jmig.2021.09.695
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