Elective, Non-urgent Procedures and Aesthetic Surgery in the Wake of SARS–COVID-19: Considerations Regarding Safety, Feasibility and Impact on Clinical Management

Abstract

Background The worldwide spread of a novel coronavirus disease has led to a near total stop of nonurgent, elective surgeries across all specialties in most affected countries. In the field of aesthetic surgery, the selfimposed moratorium for all aesthetic surgery procedures recommended by most international scientific societies has been adopted by many surgeons worldwide and resulted in a huge socioeconomic impact for most private practices and clinics. An important question still unanswered in most countries is when and how should elective/aesthetic procedures be scheduled again and what kind of organizational changes are necessary to protect patients and healthcare workers when clinics and practices reopen. Defining manageable, evidence-based protocols for testing, surgical/ procedural risk mitigation and clinical flow management/contamination management will be paramount for the safety of non-urgent surgical procedures. Methods We conducted a MEDLINE/PubMed research for all available publications on COVID-19 and surgery and COVID-19 and anesthesia. Articles and referenced literature describing possible procedural impact factors leading to exacerbation of the clinical evolution of COVID-19positive patients were identified to perform risk stratification for elective surgery. Based on these impact factors, considerations for patient selection, choice of procedural complexity, duration of procedure, type of anesthesia, etc., are discussed in this article and translated into algorithms for surgical/anesthesia risk management and clinical management. Current recommendations and published protocols on contamination control, avoidance of crosscontamination and procedural patient flow are reviewed. A COVID-19 testing guideline protocol for patients planning to undergo elective aesthetic surgery is presented and recommendations are made regarding adaptation of current patient information/informed consent forms and patient health questionnaires. Conclusion The COVID-19 crisis has led to unprecedented challenges in the acute management of the crisis, and the wave only recently seems to flatten out in some countries. The adaptation of surgical and procedural steps for a riskminimizing management of potential COVID-19-positive patients seeking to undergo elective aesthetic procedures in the wake of that wave will present the next big challenge for the aesthetic surgery community. We propose a clinical algorithm to enhance patient safety in elective surgery in the context of COVID-19 and to minimize cross-contamination between healthcare workers and patients. New evidence-based guidelines regarding surgical risk stratification, testing, and clinical flow management/contamination management are proposed. We believe that only the continuous development and broad implementation of guidelines like the ones proposed in this paper will allow an early reintegration of all aesthetic procedures into the scope of surgical care currently performed and to prepare

Cosmetic tourism amidst the Covid-19 global pandemic

“…In addition, she was not consented regarding the associated risks of contracting Covid-19 in the perioperative period. 2 At the time this procedure took place, Poland was trending towards their peak number of active cases with the highest daily number of new cases in Poland since this global pandemic began ( n = 599) recorded the day before our patients' surgery. 3 Cosmetic tourism is already known to put patients at higher risk of multiple complications which is discussed in more detail in our previous article.…”

“…In a statement also that also highlighted the concerns of post-operative care and follow-up and the risk of complications subsequently putting added pressure on health care systems. 2 The patient in question is a 43-year-old female who travelled from the United Kingdom (UK) to Poland for a circumferential abdominoplasty with 'fleur-de-lis' extension at the start of June 2020. On returning home, she required admission to an NHS hospital 3 weeks post-operatively due to wound necrosis, dehiscence and cellulitis.…”

“…The addition of a specific Covid-19 consent form will ensure informed consent in the new era of living with Covid-19. 2 The risks to patients undergoing surgery who develop a perioperative Covid-19 infection are significant and have been highlighted in a recent publication in the Lancet, including; a 51% risk of post-operative pulmonary complications and a 30-day mortality rate of 38%. 5 As we recover from this global pandemic and the world begins to normalise, we urge all surgeons undertaking aesthetic procedures to ensure they follow the relative aesthetic association guidelines to ensure both patient and staff safety.…”

Genetic analysis of the 2019 coronavirus pandemic with from real-time reverse transcriptase polymerase chain reaction

“…Symptoms may appear 2–14 days after exposure and period incubation ranges from 4 to 7 days, during which any infected patient may be asymptomatic and contagious ( Kaye et al, 2020 ). While several COVID-19 patients are asymptomatic and/or healthy, with neutralization and cell mediated tolerance of the anti-proliferative antibodies and an independent immune action.…”

Roadmap for Resuming Elective Neuroendovascular Procedures Following the First COVID-19 Surge

“…Anticipated potential limitations in health care resources (personal protective equipment (PPE), ventilators, personnel, hospital space) resulted in triaged delays of non-emergent endovascular procedures and surgeries. 1 , 2 , 3 Triaged delays carry risk, since postponing elective surgeries can lead to deteriorating patient conditions, or exposure to an unfavorable natural history event; either of which may result in irreversible injury, increased health care cost, and reduced quality of life. 3…”