Iris Publishers_World Journal of Gynecology & Womens Health (WJGWH)

Incidence and Clinical Profiles of COVID-19 In Patients with Gynecological Surgery. A Single Center Descriptive Study from Spain

Summary

Background: The inflammatory reaction after a surgical intervention could exacerbate the course of the COVID-19. We aim to determine the rate of COVID-19 and its complications among gynecological surgeries in the context of different measures taken during the pandemic period in our department.

Methods: A retrospective longitudinal observational study was conducted. Clinical records of patients who underwent gynecological surgery from March 1st to April 10th, 2020 were reviewed. During this period, three different approaches were made: first phase, without any screening or surgical restrictions; second phase, with presurgical epidemiological screening using a specific questionnaire; and third phase, also with presurgical SARS-COV-19 RT-PCR. During the second and third phases the surgical activity and complexity were restricted, and different workflows were established for patient with suspected/confirmed infection. After hospital discharge, telephone follow-up was performed and screening for COVID-19 was carried out. Complications from the disease were analyzed.

Results: Of the 118 patients that underwent gynecological surgeries, 10 (8.5%) were perioperatively diagnosed with COVID-19. Of these patients, 8 (80%) were not pre-surgical screened for SARS-CoV-2 infection, neither clinical nor with RT-PCR. The other 2 (20%) were preoperative screened with RT-PCR, one of them with a positive test result. Screening false negative rate was 0.8%. No postoperative complications derived from COVID-19 were observed.

Conclusions: The establishment of different surgical workflows, the reduction of surgical complexity, and the use of a pre-surgical screening to detect patient at SARS-CoV-2 infection risk, could reduce the postoperative complications derived from that infection and improve surgical outcomes.

Keywords: COVID-19; SARS-cov-2; Surgery; Gynecology

Abstract: COVID-19: Coronavirus Disease; SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus 2; R0: Basic Reproductive Number; ARDS: Acute Respiratory Distress Syndrome; ICU: Intensive Care Unit; RT-PCR: Quantitative RNA by Reverse Transcription Polymerase Chain Reaction; IQR: Interquartile Range

Background

At the end of 2019, a novel coronavirus disease (COVID-19) was identified as the cause of a cluster of pneumonia cases in Wuhan, a city in the Hubei Province of China. The virus that causes COVID-19 was designated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It rapidly spread, resulting in an increasing number of cases in other countries throughout the world. Since the first report of cases from Wuhan, more than 3,267,184 cases worldwide and 215,216 in Spain have been reported [1]. Madrid is one of the main focuses of the epidemic in Spain, with more than 62,205 cases reported until May 2020 [2]. The rapid increase in the number of people infected in a short period of time is mainly due to the highspeed transmission of the virus, with a calculated basic reproductive number (R0) of 2-3 [3].

The incubation period for COVID-19 is thought to be within 14 days, with the majority of cases occurring approximately four to five days following exposure [4-5]. The most common manifestations of COVID-19 include fever, dry cough, dyspnea, myalgia, asthenia, ageusia and anosmia. Most infections are not severe [6-8]. However, complications as acute respiratory distress syndrome [ARDS], arrhythmia, shock, acute cardiac injury, secondary infection, acute kidney injury and death may occur in severe cases [6, 9-11]. This emergency situation has forced health systems around the world to centralize their efforts in eradicating the disease and taking care of the infected people. Consequently, hospitals have become COVID centres and have had to modify their daily activities, including surgical ones.

Currently, the data on the clinical characteristics and outcomes of patients with SARS-CoV-2 infection or COVID-19 undergoing surgeries are rare [11,12]. However, it is postulated that the inflammatory reaction that occurs after a surgical intervention could exacerbate the course of the disease in these patients, conditioning the development of severe complications. In this study we aim to determine the rate of COVID-19 among gynecological surgeries, both prior and posterior to surgery, as well as the patient characteristics and the rate of postoperative complications derived from SARS-CoV-2 infection in the context of different measures taken during the pandemic period in our department.

Methods

Study design

A retrospective longitudinal observational study was conducted at Hospital Universitario 12 de Octubre in Madrid, one of the most affected areas of COVID-19 pandemic in Spain. This study was reviewed and approved by our hospital’s Ethics Committee. Oral consent was obtained from the patients.

We retrospectively reviewed clinical records of patients who underwent elective or urgent surgery from March 1st to April 10th, 2020. After hospital discharge, telephone follow-up was performed. Screening for symptoms associated with SARS-Cov-2 infection was carried out, and secondary complications from the disease were collected. Pregnant women and those in which postoperative telephone follow-up was not possible were excluded. Telephone calls were performed at least ten days after hospital discharge. Due to the state of alarm and the limitation of mobility of the population and assessing the risk / benefit of attending a hospital center, verbal consent was obtained during the phone call. The clinical outcomes of these patients were monitored up to April 20th, 2020, the final date of follow-up.

Information included demographic characteristics, exposure history, underlying comorbidities, chest CT image, surgical type, surgical time, signs and symptoms, time from surgery to first symptoms, COVID-19 onset and intensive care unit (ICU) admission, treatments, complications, and prognosis. The time of COVID-19 onset was defined as the date when the first sign or symptom was noticed.

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