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. 2022 Jan;51(1):102255.
doi: 10.1016/j.jogoh.2021.102255. Epub 2021 Oct 29.

Collateral damage of COVID-19 pandemic: The impact on a gynecologic surgery department

Jeanne Piketty  1 , Marie Carbonnel  2 , Rouba Murtada  1 , Aurélie Revaux  1 , Jennifer Asmar  1 , Angéline Favre-Inhofer  1 , Jean-Marc Ayoubi  1
Affiliations

Collateral damage of COVID-19 pandemic: The impact on a gynecologic surgery department

Jeanne Piketty et al. J Gynecol Obstet Hum Reprod. 2022 Jan.

Abstract

Objective: This study focuses on changes in gynecologic surgical activity at Hospital Foch, Paris, France during the first French COVID lockdown in 2020. Additional goals include the evaluation the extent of the postponement suffered for each type of surgery and estimate the possible negative impact for patients.

Study design: Single-center, retrospective, chart-review cohort study in the gynecology department of Hospital Foch. Comparison of all patients scheduled, postponed and operated during the first COVID lockdown (March 14, to May 11, 2020) versus the same period in 2019. Postponed surgeries were classified into 4 scheduling interval categories according to the Society of Gynecology Oncology (SGO) recommendations: urgent (without delay), semi-urgent (1-4 weeks), non-urgent (>4-12 weeks) and elective (>3 months) and evaluated to determine whether COVID-19-related delays of surgeries fell within guidelines. The potential "loss of chance" or medical risk associated with postponed surgeries was estimated according to a composite criterion including death, aggravation of expected tumor stages/grades in cancers, increase in surgical complexity compared to that initially planned, need for preoperative transfusions, start of morphine consumption during preoperative treatment for opiate-naive patients, additional hospitalization or consultations in emergency room and delay in treatment when surgery was urgent.

Results: During the 2020 French COVID lockdown, 61 patients had a surgical procedure and 114 were postponed; in the comparator 2019 group, 232 patients underwent surgical procedures, indicating an overall decrease of 65% of activity. Analysis of differences between the two years revealed a reduction of 64% in emergency procedures, 90% of functional pathologies, and 13% of cancers. According to SGO guidelines, the only type of surgical procedures that had excessive delay was the semi-urgent group, where time to surgery was 6.7 weeks [range 5.4-10 weeks] instead of the recommended interval of 1-4 weeks. Among postponed surgeries there were 10 patients (8.7%) with a potential "loss of chance" according to the composite criteria, all included in the semi-urgent group.

Conclusion: The COVID 19 pandemic was responsible for a significant decrease of activity in the surgical department of Hospital Foch. Difficulty of rescheduling surgeries was responsible for an increased delay in semi-urgent operations. In almost 9% of postponed surgeries, there was a potential "loss of chance", which likely represents only the tip of iceberg of collateral damages due to COVID 19 pandemic in this surgical unit. These data show the importance of continuing to treat pathologies requiring urgent or semi-urgent surgery during pandemics.

Keywords: COVID-19; Delayed surgery; Gynecology; Loss of chance; Medical risk; Surgical procedures.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig. 1
Pie chart. Proportions of surgery between 2020 and 2019 (March- 14-May 11).
Fig 2
Fig. 2
Delayed number of patients according to SGO emergency categories .
Fig 3
Fig. 3
Median Delay of surgical care according to emergency categories .
See this image and copyright information in PMC

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