Velthuijs Eva L M, Ismail Ismail, Koolman Xander, de Leeuw Robert A, Hehenkamp Wouter J K
Department of Gynaecology and Obstetrics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
Department of Health Economics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
BMJ Open. 2025 Aug 11;15(8):e100357. doi: 10.1136/bmjopen-2025-100357.
To examine the impact of the COVID-19 pandemic on the substitution of surgical procedures in benign gynaecology in the Netherlands.
Quantitative longitudinal study evaluating the effects of the COVID-19 pandemic.
Nationwide healthcare delivery was analysed across six benign gynaecological pathways from 2016 to 2022 using Vektis and Dutch Hospital Data (DHD), accessed via Statistics Netherlands (Centraal Bureau voor de Statistiek).
The study focused on six benign gynaecological pathways classified using Dutch Diagnosis Treatment Combinations (DTCs): heavy menstrual blood loss (G11), uterine fibroids (G15), endometriosis (G17), prolapse (G25), infertility treatment (F11) and first trimester pregnancy complications (Z12). All patients receiving care within these pathways between 1 January 2016 and 31 December 2022 were included. Exclusions applied to all patients under 18 years old and, only within the menstrual disorder pathway, patients over 51 years old to exclude most postmenopausal blood loss cases where no alternative treatment applies.
Cohorts from the initial pandemic year (2020) were compared with four prepandemic cohorts (2016-2019) and late-pandemic (2021) and postpandemic (2022) cohorts.
The primary outcome was the trend in the total number of patients in surgical and non-surgical procedure groups across cohort periods. Secondary outcomes included trends within individual pathways.
The analysis identified a significant reduction in benign gynaecological care during 2020, with an 18.3% (p<0.001) decrease in surgical procedures and a 6% (p=0.02) decrease in non-surgical procedures across all pathways. During the COVID-19 pandemic, surgical care showed the largest significant declines in infertility treatment (-19.3%, p<0.001) and prolapse and heavy menstrual bleeding (both -17.5%, p<0.001), while non-surgical care decreased less markedly, with the largest significant drop in prolapse care (-10.4%, p=0.001). Non-surgical procedures generally returned to pre-pandemic levels, whereas surgical care remained reduced. These differences were conducted using regression models that adjusted for time trends and the COVID-19-related impact.
The COVID-19 pandemic significantly disrupted both surgical and non-surgical procedures within benign gynaecological pathways. Reduced care uptake during the pandemic waves was not recovered but instead forgone. The reduction in surgical procedures did not correspond with increased use of non-surgical alternatives. Future research should prioritise evaluating the long-term impacts of this disruption on patients and society.
研究新冠疫情对荷兰良性妇科手术替代情况的影响。
评估新冠疫情影响的定量纵向研究。
利用通过荷兰统计局（中央统计局）获取的Vektis和荷兰医院数据（DHD），对2016年至2022年全国范围内六条良性妇科治疗途径的医疗服务提供情况进行分析。
该研究聚焦于根据荷兰诊断治疗组合（DTC）分类的六条良性妇科治疗途径：月经过多（G11）、子宫肌瘤（G15）、子宫内膜异位症（G17）、子宫脱垂（G25）、不孕症治疗（F11）和孕早期妊娠并发症（Z12）。纳入了2016年1月1日至2022年12月31日期间接受这些治疗途径护理的所有患者。排除所有18岁以下患者，且仅在月经紊乱治疗途径中，排除51岁以上患者，以排除大多数无替代治疗方法的绝经后失血病例。
将疫情第一年（2020年）的队列与四个疫情前队列（2016 - 2019年）、疫情后期（2021年）和疫情后（2022年）队列进行比较。
主要结局是各队列期间手术和非手术治疗组患者总数的趋势。次要结局包括各治疗途径内的趋势。
分析发现2020年良性妇科护理显著减少，所有治疗途径的手术治疗减少了18.3%（p<0.001），非手术治疗减少了6%（p = 0.02）。在新冠疫情期间，手术护理在不孕症治疗方面下降最为显著（-19.3%，p<0.001），子宫脱垂和月经过多方面也显著下降（均为-17.5%，p<0.001），而非手术护理下降不太明显，子宫脱垂护理下降最为显著（-10.4%，p = 0.001）。非手术治疗一般恢复到疫情前水平，而手术护理仍减少。这些差异通过调整时间趋势和新冠疫情相关影响的回归模型进行分析。
新冠疫情严重扰乱了良性妇科治疗途径中的手术和非手术治疗。疫情期间护理量的减少未恢复，而是被放弃了。手术治疗的减少与非手术替代方法使用的增加不相符。未来研究应优先评估这种扰乱对患者和社会的长期影响。
