The Impact of Covid-19 Pandemic on The Management and Outcome of Adnexal Torsion: A Retrospective Study

Author(s): Ho Ying Flora Wong, Ruoxing Du, Perita Amakiri, Lee Lim, Prasanna Raj Supramaniam

Objectives:

To evaluate the effects of COVID-19 on the management of suspected adnexal torsion

Methods:

Design:

Retrospective case-controlled cohort

Setting:

A tertiary hospital

Population:

Women who underwent emergency surgery for suspected adnexal torsion from 24th March 2019 to 23rd March 2020 (Control group) and from 24th March 2020 to 23rd March 2021 (Pandemic group)

Methods:

Electronic patient records reviewed. Parameters were compared with Mann-Whitney U and Fisher's exact tests

Primary outcome:

Time from referral to gynaecology to diagnosis of torsion and time to theatre

Secondary outcomes:

time from symptom onset to hospital presentation and oophorectomy rate

Results:

50%(25/50) of the pre-pandemic control group had adnexal torsion confirmed intra-operatively, compared to 58%(36/62) in the pandemic group. There were no statistical difference in the median time from referral to diagnosis (3 v.s. 9 hours, p=0.11) or median time from diagnosis to operation (7 v.s. 4 hours, p=0.27) between the control and pandemic groups. Out-of-hours operating was 4.5 times more likely in the pandemic group. 60%(n=15) of patients required non-ovarian sparing surgery (oophorectomy) in the control group, compared with 38%(n=14) in the pandemic group.

Conclusions:

A functional, well thought-out contingency plan in the face of a pandemic was crucial in order to prepare the hospital in times of crisis. Whilst there was an increase in the likelihood of out-of-hours operating during the pandemic, we have demonstrated that our ability to undertake diagnostic tests and to perform emergency surgery safely was not delayed overall due to the impacts of COVID-19.