Restarting plastic surgery: Drawing on the experience of the initial COVID-19 pandemic to inform the safe resumption of services

Impact of the COVID-19 pandemic on breast cancer patient pathways and outcomes in the United Kingdom and the Republic of Ireland - a scoping review

The COVID-19 pandemic brought unplanned service disruption for breast cancer diagnostic, treatment and support services. This scoping review describes these changes and their impact in the UK and the Republic of Ireland based on studies published between January 2020 and August 2023. Thirty-four of 569 papers were included. Data were extracted and results thematically organized. Findings include fewer new cases; stage shift (fewer early- and more late-stage disease); and changes to healthcare organization, breast screening and treatment. Examples are accepting fewer referrals, applying stricter referral criteria and relying more on virtual consultations and multi-disciplinary meetings. Screening service programs paused during the pandemic before enacting risk-based phased restarts with longer appointment times to accommodate reduced staffing numbers and enhanced infection-control regimes. Treatments shifted from predominantly conventional to hypofractionated radiotherapy, fewer surgical procedures and increased use of bridging endocrine therapy. The long-term impact of such changes are unknown so definitive guidelines for future emergencies are not yet available. Cancer registries, with their large sample sizes and population coverage, are well placed to monitor changes to stage and survival despite difficulties obtaining definitive staging during diagnosis because surgery and pathological assessments are delayed. Multisite longitudinal studies can also provide guidance for future disaster preparedness.

Impact of COVID-19 pandemic on plastic surgery training in Europe

BACKGROUND

The COVID-19 pandemic has disrupted the functioning of global society and healthcare systems, including surgical departments. We aimed to assess alterations in plastic surgery training in Europe during the COVID-19 pandemic.

METHODS

A 34-question survey was emailed in January and February 2021 to 54 National Associations of Plastic, Reconstructive, and Aesthetic Surgeons throughout European countries. The questions concerned the general profile of plastic surgery trainees, plastic surgery department, and training organization during the COVID-19 pandemic and its influence on respondents' health. The acquisition of responses was finalized at the end of February 2021.

RESULTS

All 71 of the respondents reported alterations in planned courses, workshops, and conferences. Organizational changes included team rotation 62%, followed by redeployment to another department 45.1%. Reduction in admissions to the plastic surgery departments was more significant during the 1st^t wave than the 2nd wave of COVID-19 pandemics. During the interim period, admission restrictions were proportional to the infection number. The most frequently reported surgical procedures performed were skin cancer surgeries, trauma, and burns (79%, 77%, and 77%). The majority, 62% of the respondents, noticed the negative impact of pandemics on training; 53.5% think their manual skills and clinical knowledge may deteriorate because of the pandemic. Respondents noticed that their mental (50.7%) and physical (32%) health worsened, along with feeling more stressed in general (57%).

CONCLUSION

The COVID-19 pandemic limited plastic surgery departments' activities and implementation of the plastic surgery training program in all European countries involved in our study.

St Andrew's COVID-19 surgery safety (StACS) study: The Burns Centre experience

Background

The COVID-19 pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has the potential to significantly impact burns patients both directly through infective complications of an immunocompromised cohort, and indirectly through disruption of care pathways and resource limitations. The pandemic presents new challenges that must be overcome to maintain patient safety; in particular, the potential increased risks of surgical intervention, anaesthesia and ventilation. This study comprehensively reviews the measures implemented to adapt referral pathways and mitigate the risk posed by COVID-19 during the height of the pandemic, within a large Burns Centre.

Methods

A prospective cohort study was designed to assess patients treated at the Burns Centre during the UK COVID-19 pandemic peak (April–May 2020), following implementation of new safety measures. All patients were analysed for 30-day mortality. In addition, a prospective controlled cohort study was undertaken on all inpatients and a random sample of outpatients with telephone follow-up at 30 days. These patients were divided into three groups (operative inpatients, non-operative inpatients, outpatients). COVID-19 related data collected included test results, contact with proven cases, isolation status and symptoms. The implemented departmental service COVID-19 safety adaptations are described.

Results

Of 323 patients treated at the Burns Centre during the study period, no 30-day COVID-19 related deaths occurred (0/323). Of the 80 patients analysed in the prospective controlled cohort section of the study, 51 underwent COVID-19 testing, 3.9% (2/51) were positive. Both cases were in the operative group, however in comparison to the non-operative and outpatient groups, there was no significant increase in COVID-19 incidence in operative patients.

Conclusions

We found no COVID-19 related mortality during the study period. With appropriate precautions, burns patients were not exposed to an increased COVID-19 risk. Similarly, burns patients undergoing operative management were not at a significantly increased risk of contracting COVID-19 in comparison to non-operative groups.