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

Abstract

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.