OBJECTIVE To describe composite 30-day postoperative complication rates among patients undergoing hysterectomy during the coronavirus disease 2019 (COVID-19) pandemic and to determine baseline and postoperative mental health symptoms, levels of social support, and socioeconomic status and their association with hysterectomy outcomes. METHODS This multicenter prospective cohort study at eight centers across the United States enrolled patients who underwent minimally invasive hysterectomy for benign indications during the COVID-19 pandemic. Patients completed preoperative and postoperative surveys assessing mental health (PHQ-9 [Patient Health Questionnaire]), social support (MOS-SS [Medical Outcomes Study Social Support Survey]), and socioeconomic status (Hollingshead Index [Hollingshead Four Factor Index of Socioeconomic Status]). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates and 30-day composite complication rates were measured and categorized by Clavien-Dindo Grade. Bivariate associations of survey data on complications were assessed. Logistic regression analyses were used to identify independent predictors of 30-day complications and complication severity. RESULTS Postoperative complications within 30 days occurred in 67 of 273 (24.5%) patients. Most (88.1%) complications were mild, but eight (11.9%) experienced severe complications. Only three patients (1.1%) tested positive for SARS-CoV-2 infection. There were no differences in complication rates when comparing race and ethnicity, age, or socioeconomic status. Survey responses that indicated more depression and worse support from preoperative to postoperative were seen in patients with severe complications ( P =.008 and P =.09, respectively). Multivariate analysis demonstrated that an increase in support scores was protective against severe complications ( P =.02). Worsening depression scores were associated with more severe complications ( P =.03). CONCLUSION This study showed a high rate of complications (24.5%) among patients who underwent hysterectomy during the COVID-19 pandemic. Lower social support and worse mental health status are associated with worse postoperative outcomes after hysterectomy.

中文翻译：

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健康和社会支持的社会决定因素对子宫切除术患者手术结果的影响。


目的 描述 2019 冠状病毒病 （COVID-19） 大流行期间接受子宫切除术的患者术后 30 天复合并发症发生率，并确定基线和术后心理健康症状、社会支持水平和社会经济地位及其与子宫切除术结果的相关性。方法 这项在美国八个中心进行的多中心前瞻性队列研究招募了在 COVID-19 大流行期间因良性适应症接受微创子宫切除术的患者。患者完成了评估心理健康（PHQ-9 [患者健康问卷]）、社会支持（MOS-SS [医疗结果研究社会支持调查]）和社会经济地位（Hollingshead 指数 [Hollingshead 社会经济地位四因素指数]）的术前和术后调查。严重急性呼吸系统综合症冠状病毒 2 （SARS-CoV-2） 感染率和 30 天复合并发症发生率按 Clavien-Dindo 分级进行测量和分类。评估了并发症调查数据的双变量关联。采用 Logistic 回归分析确定 30 天并发症和并发症严重程度的独立预测因子。结果 273 例患者中有 67 例 （24.5%） 发生术后 30 天内并发症。大多数 （88.1%） 并发症是轻微的，但 8 例 （11.9%） 出现严重并发症。只有 3 名患者 （1.1%） 的 SARS-CoV-2 感染检测呈阳性。在比较种族和民族、年龄或社会经济地位时，并发症发生率没有差异。调查回复表明，在有严重并发症的患者中，从术前到术后的抑郁程度更高，支持更差 （分别为 P =.008 和 P =.09）。 多变量分析表明，支持评分的增加对严重并发症有保护作用 （P =.02）。抑郁评分恶化与更严重的并发症相关 （ P =.03）。结论 本研究显示，在 COVID-19 大流行期间接受子宫切除术的患者并发症发生率很高 （24.5%）。较低的社会支持和较差的心理健康状况与子宫切除术后较差的术后结局相关。