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

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...

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Autores principales: PIKETTY, Jeanne, CARBONNEL, Marie, MURTADA, Rouba, REVAUX, Aurélie, ASMAR, Jennifer, FAVRE-INHOFER, Angéline, AYOUBI, Jean-Marc
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Masson SAS. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8555111/
https://www.ncbi.nlm.nih.gov/pubmed/34757223
http://dx.doi.org/10.1016/j.jogoh.2021.102255
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author PIKETTY, Jeanne
CARBONNEL, Marie
MURTADA, Rouba
REVAUX, Aurélie
ASMAR, Jennifer
FAVRE-INHOFER, Angéline
AYOUBI, Jean-Marc
author_facet PIKETTY, Jeanne
CARBONNEL, Marie
MURTADA, Rouba
REVAUX, Aurélie
ASMAR, Jennifer
FAVRE-INHOFER, Angéline
AYOUBI, Jean-Marc
author_sort PIKETTY, Jeanne
collection PubMed
description 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.
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spelling pubmed-85551112021-10-29 Collateral damage of COVID-19 pandemic: The impact on a gynecologic surgery department PIKETTY, Jeanne CARBONNEL, Marie MURTADA, Rouba REVAUX, Aurélie ASMAR, Jennifer FAVRE-INHOFER, Angéline AYOUBI, Jean-Marc J Gynecol Obstet Hum Reprod Original Article 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. Elsevier Masson SAS. 2022-01 2021-10-29 /pmc/articles/PMC8555111/ /pubmed/34757223 http://dx.doi.org/10.1016/j.jogoh.2021.102255 Text en © 2021 Elsevier Masson SAS. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Original Article
PIKETTY, Jeanne
CARBONNEL, Marie
MURTADA, Rouba
REVAUX, Aurélie
ASMAR, Jennifer
FAVRE-INHOFER, Angéline
AYOUBI, Jean-Marc
Collateral damage of COVID-19 pandemic: The impact on a gynecologic surgery department
title Collateral damage of COVID-19 pandemic: The impact on a gynecologic surgery department
title_full Collateral damage of COVID-19 pandemic: The impact on a gynecologic surgery department
title_fullStr Collateral damage of COVID-19 pandemic: The impact on a gynecologic surgery department
title_full_unstemmed Collateral damage of COVID-19 pandemic: The impact on a gynecologic surgery department
title_short Collateral damage of COVID-19 pandemic: The impact on a gynecologic surgery department
title_sort collateral damage of covid-19 pandemic: the impact on a gynecologic surgery department
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8555111/
https://www.ncbi.nlm.nih.gov/pubmed/34757223
http://dx.doi.org/10.1016/j.jogoh.2021.102255
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