The Impact of the Covid-19 Surgical Pause on Operative Timings Elective Benign Gynaecological Surgery

STUDY OBJECTIVE: To assess the impact of Covid-19 global pandemic and surgical pause on operative timings in gynaecology. DESIGN: Retrospective cohort study of all laparoscopies and laparotomies undertaken in our gynaecological department (01/01/2019 - 31/12/2020). Cases and timings were identified using computerised theatre records and analysed using Excel. SETTING: Large National Health Service (NHS) University hospital in the United Kingdom PATIENTS OR PARTICIPANTS: All gynaecological laparoscopies and laparotomies over 2-year period. INTERVENTIONS: The monthly median timings (anaesthetic, surgical, operative) were compared for 15 months (January 2019 - March 2020) preceding the Covid-19 measures being implemented with the subsequent 9 months (April - December 2020). The gynae-onccology, emergency and elective gynaecology groups were analysed separately to allow secondary assessment of the impact of surgical pause on surgical timings. MEASUREMENTS AND MAIN RESULTS: 1565 cases were performed (886 benign elective, 158 emergencies, 522 gynae-oncology) averaging 77 cases/month pre-Covid-19, 27 cases/month in the initial 3 months and 59 cases/month for the subsequent 6 months. The monthly median anaesthetic time increased from 25-31 minutes pre-Covid-19 to 50-53 minutes in the initial 3 months, with a slow return towards baseline over the subsequent 6 months (33-47 minutes). Surgical timings stayed within average monthly fluctuations in gynae-oncology and emergencies, however a clinically significant peak (245 minutes) was observed in benign elective operating times in the first full month of return compared to pre-Covid-19 (46-102 minutes). CONCLUSION: There was a clinically significant increase in operative times following implementation of Covid-19 measures. The widest clinical impact was near doubling of anaesthetic time over the initial 3 months. The 6-week pause in operating also appeared to impact elective benign gynaecological surgical timings, however continued operating in gynae-oncology and emergencies appeared to have a protective effect on timings. These findings can aid effective surgical list planning to allow sufficient time for the additional measures on the return after the larger second wave.