Practice changes in Italian Gynaecologic Units during the COVID-19 pandemic: a survey study

Abstract

The impact of Coronavirus disease 2019 pandemic on Italian Gynaecological Units practice and the compliance and satisfaction with available guidelines/recommendations is unknown. Therefore, a survey was conducted among all Italian Gynaecological Units Directors in April 2020. The response rate was 90% (135/150). 77.8% of centres performed surgery only for oncologic or not deferrable pathologies, and 9.6% was closed. 68.7% of directors were at least moderately satisfied by published guidelines/recommendations, but 94.8% of respondents identified limitations, mainly (83%) the absent definition of benign non-deferrable pathology. Responders considered as non-deferrable severe endometriosis (69.6%), endometriosis with organ failure/dysfunction (74.1%), and unresponsive symptomatic fibroids (89.6%). Despite guidelines/recommendations, respondents treated ovarian (77%) and endometrial (71.6%) cancer as usual. Only a minority of respondents reduced the laparoscopic approach (11.2%) and adopted all recommended surgical precautions (9.6%). Compliance with available guidelines/recommendations appears incomplete. Reconsidering guidelines/recommendations regarding oncological cases and specify non-deferrable benign pathologies would improve guidelines/recommendations compliance.

Impact statement

• What is already known on this subject? The SARS-CoV-2 pandemic has profoundly influenced medical routine practice worldwide. Surgery units have been forced to reduce or even completely restrict their activity to re-allocate human resources. Many major international gynaecological societies have released statements and guidelines, providing various recommendations to guide practice changes. However, the impact of the SARS-CoV-2 pandemic on Italian Gynaecological Units practice and the compliance and satisfaction with available guidelines/recommendations is unknown.

• What do the results of this study add? Study results provide evidence showing how the SARS-CoV-2 pandemic has changed surgical activity in the Italian Gynaecological Units. Most centres reduced surgical activity, limiting surgery only for oncologic or not deferrable pathologies. Moreover, our research shows the level of compliance and satisfaction with available guidelines/recommendations and where they need to be improved. Most directors were at least moderately satisfied but identified different limitations. Guidelines/recommendations do not provide enough details, such as the absent definition of benign non-deferrable pathologies.

• What are the implications of these findings for clinical practice and/or further research? The limited compliance with available guidelines/recommendations and identified limitations suggest reconsidering guidelines/recommendations focussing on identified gaps. Provide more details, such as specifying non-deferrable benign pathologies, would improve guidelines/recommendations compliance.

Keywords:

• COVID-19
• SARS-CoV-2
• gynaecological surgery
• gynaecological cancer
• guidelines adherence
• organisation

Acknowledgements

The authors thank the contribution of Giovanni Aletti, Roberto Angioli, Alberto Arnulfo, Roberto Baccichet, Francesco Battaglia, Roberto Berretta, Andrea Bianciotto, Roberto Biggiogera, Nicoletta Biglia, Gian Luca Bracco, Carlo Maria Bulgheroni, Enrico Busato, Marco Camanni, Massimo Candiani, Giampiero Capobianco, Marcello Ceccaroni, Vito Chiantera, Antonio Cianci, Andrea Ciavattini, Nicola Colacurci, Francesco Cosentino, Fabrizio Damiani, Davide De Vita, Davide Dealberti, Enrico Di Mambro, Carlo Dorizzi, Lorenza Driul, Giorgio Epicoco, Alfredo Ercoli, Fabio Facchinetti, Laura Favretti, Angiolo Gadducci, Franco Garbin, Giorgia Garganese, Giorgio Giorda, Piero Grassano, Pantaleo Greco, Stefano Greggi, Maurizio Guido, Fabio Landoni, Livio Leo, Marco Liberati, Antonino Lo Re, Tiziano Maggino, Francesco Maneschi, Mario Massacesi, Alberto Mattei, Marta Mazzarini, Michele Morelli, Luigi Nappi, Enrico Negrone, Giorgio Nicolanti, Giuseppe Nucera, Stefano Palmieri, Anna Maria Paoletti, Giancarlo Paradisi, Alessandra Perutelli, Giovanni Pontrelli, Andrea Puppo, Francesco Raspagliesi, Aldo Riccardi, Cesare Romagnolo, Daniela Romualdi, Roberto Rulli, Maria Giovanna Salerno, Enrico Sartori, Sergio Schettini, Marcello Scollo, Paolo Scollo, Renato Seracchioli, Fabrizio Signore, Tommaso Simoncini, Arsenio Spinillo, Martin Steinkasserer, Guido Stevenazzi, Emilio Stola, Daniela Surico, Saverio Tateo, Raffaele Tinelli, Marco Torrazzina, Giuseppe Trojano, Vito Trojano, Federico Tuo, Nicoletta Vendola, Roberta Venturella, Paolo Vercellini, Mario Vicino, Michele Antonio Vignali, Enrico Vizza, Paolo Zampriolo, Giuliano Zanni and Fulvio Zullo.

This study was not funded.

Ethical approval

The study was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The design, analysis, interpretation of data, drafting, and revisions conform to the Committee on Publication Ethics (COPE) guidelines (http://publicationethics.org/). The survey and the study used anonymized data and were exempted from approval by the ethics committee of ASL Biella. Consent to participate and to allow anonymized data collection and analysis was implied by accessing and filling the anonymous survey by participants, who were free to participate or not participate. The study was non-advertised, and no remuneration was offered to encourage subjects to participate.

Author contributions

All the authors conform to the International Committee of Medical Journal Editors (ICMJE) criteria for authorship, contributed to the intellectual content of the study, and gave approval for the final version of the article. M Franchi, S Uccella, G Scambia, A Cromi, M Malzoni, J Casarin, and F Ghezzi: study conceptualisation. S Uccella, M Franchi, and S Garzon: study design. G Lanzo, PC Zorzato, and S Garzon: dataset management and statistical analyses. M Franchi, S Uccella, and F Ciccarone: project administration, methodology validation, and supervision. S Uccella, G Lanzo, PC Zorzato, M Bosco, and I Porcari: manuscript writing/editing. All authors contributed to the interpretation of results, as well as to the writing and editing of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

All data are fully available without restriction within the manuscript.