Introduction
The COVID-19 pandemic has had a significant impact on surgical services
in the UK, with more than 1.5 million operations cancelled or postponed
in 2020. In order to increase ITU capacity to care for ventilated
patients, operating theatres throughout the country were transformed
into high-dependency units. Anaesthetists required for elective surgery
were unavailable as their unique skills in caring for the critically ill
were needed for COVID patients. Many other non-emergency teams and
healthcare professionals were redeployed to help as frontline workers to
combat the pandemic and treat afflicted patients. Many other staff have
been unable to work in operating theatres due to illness or shielding
for pre-existing health conditions. Patients have faced reduced access
to general practitioner (GP) services and specialist surgical clinics,
all of which have prevented or delayed the scheduling of operations.
Prior to the pandemic patients already faced long waits for elective
surgery, and this is particularly true of endometriosis surgery.
Endometriosis patients in the UK wait on average 8 years for diagnosis
alone, and 30% wait more than 10 months for surgery. The delay in
surgery incurs secondary economic costs such as time out of education
and employment, and places additional strain on emergency services from
attendances for uncontrolled pain. It is vital that the backlog of
endometriosis surgery is quantified, and a plan is made to reduce the
waiting times for endometriosis surgery to a sustainable level. The
pandemic will undoubtedly have adversely impacted this position,
although the distribution and scale of the interruption to endometriosis
surgery is not yet known.
The British Society for Gynaecological Endoscopy (BSGE) is an
organisation set up by clinicians to improve standards, training and
exchange of information in gynaecological minimal access surgery, and is
the primary national aggregator of data on endometriosis surgery in the
UK. To gain accreditation as a BSGE-approved endometriosis centre, a
unit must provide data on complex operations to a centralised database
which is audited annually to maintain accreditation. This database
provides a register of the state of surgical services for severe
endometriosis in the UK, and therefore has the potential to help assess
the impact of the COVID-19 pandemic on these services. The purpose of
this study is to assess the impact of COVID-19 on surgery for severe
endometriosis at a national, regional and centre-level using the BSGE
database, and to assess the correlation between pandemic severity and
disruption to these services.