Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, (Dr. Spurlin).
Division of Gynecologic Specialty Surgery, Department of Obstetrics and Gynecology, New York Presbyterian Hospital, Columbia University Irving Medical Center, (Drs. Han, Advincula, and H. Hur).
J Minim Invasive Gynecol. 2021 Jul;28(7):1411-1419.e1. doi: 10.1016/j.jmig.2020.11.012. Epub 2020 Nov 26.
The purpose of this study was to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on surgical volume and emergency department (ED) consults across obstetrics-gynecology (OB-GYN) services at a New York City hospital.
Retrospective cohort study.
Tertiary care academic medical center in New York City.
Women undergoing OB-GYN ED consults or surgeries between February 1, 2020 and April 15, 2020.
March 16 institutional moratorium on elective surgeries.
The volume and types of surgeries and ED consults were compared before and after the COVID-19 moratorium. During the pandemic, the average weekly volume of ED consults and gynecology (GYN) surgeries decreased, whereas obstetric (OB) surgeries remained stable. The proportions of OB-GYN ED consults, GYN surgeries, and OB surgeries relative to all ED consults, all surgeries, and all labor and delivery patients were 1.87%, 13.8%, 54.6% in the pre-COVID-19 time frame (February 1-March 15) vs 1.53%, 21.3%, 79.7% in the COVID-19 time frame (March 16-April 15), representing no significant difference in proportions of OB-GYN ED consults (p = .464) and GYN surgeries (p = .310) before and during COVID-19, with a proportionate increase in OB surgeries (p <.002). The distribution of GYN surgical case types changed significantly during the pandemic with higher proportions of emergent surgeries for ectopic pregnancies, miscarriages, and concern for cancer (p <.001). Alternatively, the OB surgery distribution of case types remained relatively constant.
This study highlights how the pandemic has affected the ways that patients in OB-GYN access and receive care. Institutional policies suspending elective surgeries during the pandemic decreased GYN surgical volume and affected the types of cases performed. This decrease was not appreciated for OB surgical volume, reflecting the nonelective and time-sensitive nature of obstetric care. A decrease in ED consults was noted during the pandemic begging the question "Where have all the emergencies gone?" Although the moratorium on elective procedures was necessary, "elective" GYN surgeries remain medically indicated to address symptoms such as pain and bleeding and to prevent serious medical sequelae such as severe anemia requiring transfusion. As we continue to battle COVID-19, we must not lose sight of those patients whose care has been deferred.
本研究旨在评估 2019 年冠状病毒病（COVID-19）大流行对一家纽约市医院妇产科（OB-GYN）服务的手术量和急诊（ED）咨询的影响。
回顾性队列研究。
纽约市的一家三级保健学术医疗中心。
2020 年 2 月 1 日至 2020 年 4 月 15 日期间接受 OB-GYN ED 咨询或手术的女性。
3 月 16 日机构选择性手术暂停。
比较 COVID-19 暂停前后手术和 ED 咨询的数量和类型。在大流行期间，ED 咨询和妇科（GYN）手术的平均每周量减少，而产科（OB）手术保持稳定。在 COVID-19 时间框架内（3 月 16 日至 4 月 15 日），OB-GYN ED 咨询、GYN 手术和 OB 手术相对于所有 ED 咨询、所有手术和所有分娩和分娩患者的比例分别为 1.87%、13.8%和 54.6%，而在 COVID-19 之前的时间框架内（2 月 1 日至 3 月 15 日），比例分别为 1.53%、21.3%和 79.7%，OB-GYN ED 咨询（p=0.464）和 GYN 手术（p=0.310）无显著差异，OB 手术比例显著增加（p<0.002）。大流行期间 GYN 手术病例类型的分布发生了显著变化，异位妊娠、流产和癌症相关的紧急手术比例较高（p<0.001）。相反，OB 手术病例类型的分布相对保持不变。
本研究强调了大流行如何影响妇产科患者获得和接受护理的方式。在大流行期间暂停选择性手术的机构政策减少了妇科手术量，并影响了手术类型。OB 手术量没有减少，这反映了产科护理的非选择性和时间敏感性。大流行期间注意到 ED 咨询量减少，引发了一个问题：“所有的紧急情况都到哪里去了？”虽然暂停选择性手术是必要的，但“选择性”妇科手术仍然需要治疗疼痛和出血等症状，并预防严重的医疗后果，如需要输血的严重贫血。随着我们继续与 COVID-19 作斗争，我们绝不能忽视那些被推迟治疗的患者。
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