Retrospective cohort study SETTING: Tertiary-care academic medical center in New York City PATIENTS OR PARTICIPANTS: Women undergoing OB/GYN ED consults or surgeries between February 1 to April 15.
March 16th institutional moratorium on elective surgeries MEASUREMENTS AND MAIN RESULTS: 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 GYN surgeries decreased, while OB surgeries remained stable. The proportions of OBGYN 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 timeframe (February 1 to March 15) versus 1.53%, 21.3%, 79.7% in the COVID timeframe (March 16 to April 15), representing no significant difference in proportions of OBGYN ED consults (p=0.464) and GYN surgeries (p=0.310) before and during COVID, with 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 ectopics, 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 impacted the ways OB/GYN patients access and receive care. As expected, 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 non-elective 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.
Copyright © 2020. Published by Elsevier Inc.