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.