Global burden on healthcare system by COVID-19 patients had a significant impact on non-COVID diseases treatment.1-3 This study compares the characteristics of adnexal masses surgery in girls and adolescents during the 2020 and 2021 COVID-19 pandemic with the homologous non-COVID-19 period in 2018 and 2019.

A retrospective observational study using medical records of girls under 19 years of age with surgery of adnexal masses. Patients with neonatal cysts and patients with differences of sex development were excluded from the study.

Mother and Child Health Care Institute of Serbia ‘Dr Vukan Cupic’ (Belgrade, Serbia). The study was approved by the Clinical Research Committee of the Institution.

Patients (N=130) who had surgery for adnexal masses, of whom 49 with ovarian torsion.

Patients were diagnosed in the Institute, but also in other health institutions that referred them for final treatment to the Institute. Surgery was usually performed by gynecologists, and sometimes by pediatric surgeons as urgent abdominal operations. Open or minimally invasive approaches were used, depending on the medical indications, surgeon's experience, and the circumstances related to the organization of work in the COVID-19 period.

All data of the main outcome measures are shown in Table 1. In the COVID-19 period, the time from the onset of symptoms to diagnosis is statistically significantly longer than in the non-COVID-19 period (t=2,151; p=0,034). In the COVID-19 period, there were statistically significantly fewer adnexal masses surgery than in non-COVID-19 period (χ2=8,892; p=0,003). There was also decrease in number of surgically treated patients with twisted adnexal masses, but without statistical significance. Ovarian preservations in benign adnexal processes were statistically more frequent in the non-COVID-19 period (χ2=6,575; p=0,01). There was increase in percentage of adnexectomies in the COVID-19 period. During the COVID-19 period, the number of laparoscopic procedures decreased significantly, which could be associated with the technical issues and deficit in medical staff during that period (χ2=50,915; p < 0,001).

Advice on reducing non-necessary visits to the doctor given to patients during the COVID-19 pandemic led to a decrease in number of surgical procedures for adnexal masses in girls and adolescents. This also caused prolonged time to diagnosis, but did not affect the interval from the symptoms onset to operation. Reduction of number of laparoscopic procedures and ovarian preservation in benign adnexal diseases indicates a decline in the quality of health care during COVID-19 pandemic.