Patient Characteristics Associated with Delays to Benign Gynecologic Surgery: Impact of the COVID-19 Pandemic

McClurg, A. B.; Silverstein, R. G.; Moore, K. J.; Louie, M.

Study Objective To examine how demographic and socioeconomic characteristics impact timing of minimally invasive gynecologic surgery (MIGS) before and during the COVID-19 pandemic. Design Retrospective cohort study using electronic medical record data. Primary outcome was interval between referral to MIGS and date of surgery. Setting Tertiary-level MIGS division in the southeast US. Patients or Participants Historical cohort undergoing surgery with MIGS 2014-2016 (n=377) and cohort in 2020 referred during the pandemic (n=191). Interventions Laparoscopic hysterectomy, myomectomy, adnexal surgery, or excision of endometriosis. Measurements and Main Results Patient demographics (race, age, marital status, language, insurance, and socioeconomic factors) were evaluated for significant associations with surgical delay. Patients with fibroids and abnormal uterine bleeding had a shorter interval to surgery (median 95 days, range 66-133) compared to patients with chronic pelvic pain (median 127 days, range 73-274). Our model adjusting for surgical indication revealed that single patients were 2.13 times as likely to wait >90 days (95% CI 1.35-3.36) compared to partnered patients prior to the pandemic. Additionally, those in the lowest quartile of median household income (<$42,572 vs > $75,020; OR 2.42, 95% CI 1.32, 4.46) and those from zip codes with the highest proportion of population in poverty (≥ 0.20 vs <0.07; OR 1.93, 95% CI 1.04, 3.6) were more likely to wait > 90 days. However, all of these differences disappeared during the pandemic. There were no differences in time to surgery by race, ethnicity, language, population density, markers of education by zip code, or insurance before or during the pandemic. Conclusion Historically, race and socioeconomic factors are associated with decreased access to MIGS and vulnerable populations were disproportionately affected by the COVID-19 pandemic. Despite this, we found decreased time to surgery at our institution, and previous socioeconomic disparities associated with scheduling delays were improved during the pandemic, suggesting improved equitable access to tertiary-level MIGS.