Impact of the COVID-19 pandemic on breast surgery and breast reconstruction in a Japanese university hospital setting

Shibata, Dai; Kawate, Takahiko; Komiya, Takako; Nakamura, Itaru; Ishikawa, Takashi; Matsumura, Hitoshi

doi:10.5999/aps.2021.01438

Cited by 5 publications

(5 citation statements)

References 20 publications

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“…The COVID-19 pandemic has profoundly impacted health care practices across the world, including the delivery of reconstructive surgery. [11][12][13][14][15][16] In this retrospective review of COVID-19 incidence among patients undergoing flap reconstruction at a high-volume institution during the early pandemic, we found five cases of community-acquired and no cases of hospital-acquired COVID-19. Additionally, there were no significant differences in 30-day readmissions, medical outcomes, or surgical outcomes (including flap takebacks) between patients who underwent free flap reconstructive surgery before and during the early pandemic.…”

Section: Discussionmentioning

confidence: 82%

Reintroducing Flap Reconstruction: One Institution's Safe Return to Flap Surgery during the COVID-19 Pandemic

Chen

Chow

Lee

et al. 2022

J Reconstr Microsurg

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Background Prevention of nosocomial coronavirus disease 2019 (COVID-19) infection for patients undergoing flap-based reconstructive surgery is crucial to providing care and maintaining operative volume and income to support plastic surgery programs. We conducted this study to (1) determine the postoperative incidence of COVID-19 among patients undergoing flap reconstruction from December 1, 2019 to November 1, 2020 and (2) compare 30-day outcomes between patients who underwent surgery before and during the early pandemic. Methods We conducted an 11-month retrospective cohort study of all patients who underwent flap reconstruction across our institution. We abstracted patient demographics, intraoperative management, COVID-19 testing history, and 30-day postoperative complications from electronic health records. Nosocomial COVID-19 infection was defined as reverse transcription polymerase chain reaction (RT-PCR) viral ribonucleic acid detection within 30 days of patients' postoperative course or during initial surgical admission. We used chi-squared tests to compare postoperative outcomes between patients who underwent surgery before (prior to March 12, 2021, when our institution admitted its first COVID-19 patient) versus during (on/after March 12, 2021) the pandemic. Results Among the 220 patients (mean [standard deviation] age = 53.8 [18.1] years; female = 54.8%) who underwent flap reconstruction, none had nosocomial COVID-19 infection. Five (2%) patients eventually tested COVID-19 positive (median time from surgery to diagnosis: 9 months, range: 1.5–11 months) with one developing partial flap loss while infected. Between patients who underwent free flap surgery before and during the pandemic, there were no significant differences in 30-day takebacks (15.6% vs. 16.6%, respectively; p > 0.999), readmissions (9.4% vs. 12.6%, respectively; p = 0.53), and surgical complications (e.g., total flap loss 1.6% vs. 2.1%, p = 0.81). Conclusion Robust precautions can ensure the safety of patients undergoing flap surgeries across an academic medical institution, even during periods of high COVID-19 admission rates. Further studies are needed to generate evidence-based guidelines that optimize infection control and flap survival for patients undergoing reconstruction.

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Section: Discussionmentioning

confidence: 82%

Reintroducing Flap Reconstruction: One Institution's Safe Return to Flap Surgery during the COVID-19 Pandemic

Chen

Chow

Lee

et al. 2022

J Reconstr Microsurg

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“…As such, only five patients had surgery between January 2020 and the end of the study period (May 2022), with two cases of conventional mastectomy without reconstruction during this later time period. It would be useful to characterise the future trends in reconstructive practices post-pandemic with recent events having accelerated a decline in autologous tissue reconstruction [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Bilateral risk-reducing mastectomy and reconstruction–A 12-year review of methodological trends and outcomes at a tertiary referral centre

et al. 2023

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Introduction Bilateral risk-reducing mastectomy (BRRM) involves removal of healthy breast tissue to substantially decrease the risk of developing breast cancer in individuals with greater susceptibility due to a strong family history or genetic mutation. This retrospective study evaluates cases of BRRM and associated reconstruction performed at a tertiary centre, with emphasis on mastectomy and reconstructive trends. Methods A retrospective review of all BRRM cases performed between January 2010 and May 2022 was conducted, with two separate cohorts corresponding to the earlier (group 1) and later (group 2) portion of the time-period. Data collected included demographics, genetic test results, family history of breast/ovarian cancer, co-morbidities, mastectomy type, reconstruction type, surgical histopathology findings and post-operative complications. Results A total of 82 patients (group 1 = 41, group 2 = 41) underwent BRRM. The proportion of nipple-sparing mastectomy increased from 14.6% to 56.1% between the two time periods with a reduction in skin-sparing mastectomies from 75.6% to 20.3% (p<0.001). Of the 80 patients who opted to undergo reconstruction, there was a significant decrease in combined flap-implant reconstructions (19.51% to 0%, p<0.01). Importantly, for implant-only reconstruction, there were significant increases in prepectoral approaches (p = 0.0267) and use of acellular dermal matrix (ADM) (48.15% to 90.63%, p<0.001). Conclusion This study documents recent increases in nipple-sparing techniques for BRRM compared to more traditional skin-sparing methods. Concurrently, reconstruction following RRM has become predominantly implant-based without a flap, coinciding with more widespread usage of ADM. This is consistent with national trends towards fewer complex autologous procedures.

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“…Experiences from a Japanese academic medical center revealed that over 50% of reconstructive surgeries were postponed between April and July 2020, with the majority delayed at the surgeons' request due to risk of COVID-19 exposure. 5 In Canada, a national survey of plastic surgeons revealed that during the initial wave of COVID-19 between March and April 2020 survey respondents experienced a 78% decrease in volume of reconstructive surgery, with 27.4% reporting complete cessation of reconstructive surgery in their practice. 6 In the United States, institutions that proceeded with immediate IBR following mastectomy during the height of the pandemic reported complication rates similar to prepandemic levels and a preference for same-day discharge.…”

mentioning

confidence: 99%

“…While single-institution experiences and surveys of plastic surgeons have provided small-scale insight into the impact of COVID-19 on breast reconstruction, 4 5 6 7 few studies have been published providing a large, national-level investigation on the volume and quality of breast reconstruction during 2020. Hemal et al recently published a systematic review of the evidence available for surgeons during the COVID-19 pandemic.…”

mentioning

confidence: 99%

The Impact of COVID-19 on Breast Reconstruction: A Nationwide Analysis Utilizing NSQIP

Pires

Moss

Sudduth

et al. 2023

J Reconstr Microsurg Open

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Background The coronavirus disease 2019 (COVID-19) global pandemic prompted an unprecedented contraction in surgical volume. This utilizes the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database to assess the impact of COVID-19 on breast reconstruction surgery volume and quality throughout 2020. Methods The NSQIP database was utilized to gather data from 2015 to 2020. We provide descriptive statistics in the form of mean (standard deviation), median (interquartile range), and range for continuous variables and counts (%) for categorical variables. A Kruskal–Wallis test was used to compare average age and a chi-squared test was used to compare other demographic categorical variables from 2019 to 2020. Results Breast reconstruction procedures decreased by 27% in Q2 2020 compared to Q2 of 2019. Immediate tissue-expander-based reconstruction was the only type of reconstruction that increased in comparison to Q2 2019 values (53.5 vs. 41.1%, p < 0.001). Rates of delayed direct to implant reconstruction was decreased (12.8 vs. 17.5%, p < 0.001) and free flap-based breast reconstruction decreased, including immediate free flap reconstruction (5.3 vs. 9%, p < 0.001) and delayed free flap reconstruction (5.7 vs. 9.1%, p < 0.001). Immediate direct to implant reconstruction rates were unchanged. In terms of surgical quality, there were no statistically significant increases in postoperative complications, readmissions, or reoperations. Conclusion Breast reconstruction surgery was heavily impacted in Q2 of 2020 with a 27% decrease in total surgical volume. There was an increase in immediate tissue-expander-based reconstruction and decrease in rates of both direct to implant and free-flap based reconstruction. Surgical quality and outcomes remained unchanged through the pandemic.

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Impact of the COVID-19 pandemic on breast surgery and breast reconstruction in a Japanese university hospital setting

Cited by 5 publications

References 20 publications

Reintroducing Flap Reconstruction: One Institution's Safe Return to Flap Surgery during the COVID-19 Pandemic

Reintroducing Flap Reconstruction: One Institution's Safe Return to Flap Surgery during the COVID-19 Pandemic

Bilateral risk-reducing mastectomy and reconstruction–A 12-year review of methodological trends and outcomes at a tertiary referral centre

The Impact of COVID-19 on Breast Reconstruction: A Nationwide Analysis Utilizing NSQIP

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