<div>Authors:
Dr Jonathan Lewin, University College London Hospital, Department of
Gynaecology. 235 Euston Road London NW1 2BU
Professor
Ertan Saridogan, University College London Hospital, Department of
Gynaecology. 235 Euston Road London NW1 2BU
Mr Dominic
Byrne, Royal Cornwall Hospital, Department of Gynaecology. Treliske,
Truro TR1 3LJ
Professor Thomas Justin Clark, Birmingham
Women’s and Children’s Hospital, Department of Gynaecology. Mindelsohn
Way, Birmingham B15 2TG
Mr Arvind Vashisht, University
College London Hospital, Department of Gynaecology. 235 Euston Road
London NW1 2BU</div><div>Corresponding Author:
Dr Jonathan Lewin. Contact Address: Flat F, 14 John Spencer Square,
London N1 2LZ. Tel: +447968842291. Email:
Jonathan.lewin1@nhs.net</div><div>Running Title:
Impact of COVID-19 on endometriosis surgery in the UK</div><div>Full Abstract: 
 
Objective:
To determine the impact of the COVID-19 pandemic on surgery for severe
endometriosis in the UK at a national, regional and centre-level.</div><div>Design:
Population-based national cohort study.
Population: All
women undergoing endometriosis surgery requiring dissection of the
pararectal space in the UK from 2017 to 2020
inclusive.
Methods:
The British Society for Gynaecological Endoscopy (BSGE) collects data
nationally on all operations for severe endometriosis which involve
dissection of the pararectal space. Annual audits of this database were
obtained from the BSGE. Publicly available data on COVID-19 deaths and
population were obtained from the UK Office for National Statistics.
Main outcome measures: Numbers of annual BSGE-registered endometriosis
operations.
Results:
A total of 5916 operations were performed. The number of operations
decreased by 49.4% overall between 2019 and 2020. The number of
endometriosis centres remained the same, however the median number of
operations per centre decreased from 21 to 12.5, with a median
percentage decrease at each centre of 51.0% (IQR 29.4% – 75.0%).
There was no significant change in the type of surgery performed. All 11
administrative regions of Great Britain had reduced numbers of
BSGE-registered operations in 2020 compared with the average for
2017-2019, with a median 56.6% decrease (range 6.13% - 68.62%).
Regional reduction in operations was significantly correlated with
COVID-19 death rates (r=0.557, 95% CI of r 0.048 – 1.00,
p=0.037).
Conclusions:
There has been a dramatic fall in the number of operations for severe
endometriosis in Britain during the COVID-19
pandemic.
Funding: None
Keywords:
Endometriosis, COVID-19, Pandemic, BSGE</div><div>Tweetable Abstract: 
 The number of operations for severe endometriosis in Britain fell by
49% in 2020 vs pre-pandemic levels.</div>