Otolaryngology in the Time of Corona: Assessing Operative Impact and Risk During the COVID‐19 Crisis

Kuhar, Hannah N.; Heilingoetter, Ashley; Bergman, Maxwell; Worobetz, Noah; Chiang, Tendy; Matrka, Laura

doi:10.1177/0194599820930214

Cited by 16 publications

(18 citation statements)

References 20 publications

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“…While this information has yet to be described for cleft surgeries, similar observations were noted in patients undergoing other surgical procedures. 13,25,26 Interestingly, we did not observe a statistically significant differences in time under anesthesia despite the addition of supplementary perioperative protocols. It should be noted, however, that our preoperative screening protocols allowed our institution to implement less disruptive perioperative protocols given its reliability at preventing COVID-positive patients from entering the operating room.…”

Section: Discussionmentioning

confidence: 50%

Impact of COVID-19 on Cleft Surgical Care

Ferry

Beh

Dibbs

et al. 2021

FACE

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Background: Coronavirus disease 2019 (COVID-19) has greatly impacted pediatric healthcare facilities throughout the United States due to widespread case rescheduling and the implementation of supplementary COVID-19 perioperative protocols. To our knowledge, no studies have investigated the impact of COVID-19 on case volume, surgical timing, or operational aspects of cleft surgical procedures. The aim of this study is to investigate the impact that COVID-19 has had on cleft surgical care at our institution. Methods: A retrospective study comparing cleft surgical care in 2019 (the pre-pandemic cohort) and 2020 (the COVID-19 cohort) was designed. All patients who underwent a cleft surgical procedure from April 1st to August 31st in 2019 and 2020 were included for analysis. Procedures were stratified into 4 groups: primary cleft lip repairs, primary cleft palate repairs, alveolar bone grafting procedures, and revisional/secondary repair procedures. Variables investigated in this study included: surgical volume, number of patients receiving timely surgery, causes for untimely surgery, number of combined cases, number of delayed cases, delay time, time under anesthesia, and procedure length. Results: A total of 191 cleft surgeries, 102 in 2019 and 89 in 2020, were identified during the study period. We observed no statistically significant differences in cleft surgical volume and other investigated variables across all surgical subgroups from 2019 to 2020. Conclusion: Cleft surgical care was largely unaffected by COVID-19 despite high rates of case rescheduling and the addition of supplementary perioperative safety protocols. More studies are needed to assess the impact of COVID-19 on cleft surgical care at other cleft centers and to investigate the long-term outcomes of these patients.

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Section: Discussionmentioning

confidence: 50%

Impact of COVID-19 on Cleft Surgical Care

Ferry

Beh

Dibbs

et al. 2021

FACE

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“…Numerous otolaryngological publications discuss the high risk of ENT procedures and emphasize the need for comprehensive guidelines [ 22 – 24 ]. In practice, Kuhar et al reported an extremely high percentage of aerosol-generating otolaryngological procedures in Ohio [ 25 ]. Furthermore, a few studies documented the development of patient numbers during the COVID-19 pandemic, but mostly lack in-depth statistical analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, a few studies documented the development of patient numbers during the COVID-19 pandemic, but mostly lack in-depth statistical analysis. Kuhar et al found a large drop in surgical procedures in the United States, but did not study further subcategories [ 25 ]. Ralli et al demonstrated a decrease in operative procedures mainly driven by a drop in procedures for abscesses and nasal bone fractures in Italy, while numbers of cancer surgery remained stable [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Collateral damage of the COVID-19 pandemic: an alarming decline in critical procedures in otorhinolaryngology in a German university hospital

Riemann

Speck

Gerstacker

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose The COVID-19 pandemic has a major impact on the diagnosis and treatment of ENT patients. The aim of this study was to analyze the influence of the pandemic on the number of otolaryngological procedures, particularly for critical diagnoses with potential negative effects due to prolonged symptom duration. Methods We evaluated 10,716 surgical procedures between January 1, 2018 and May 31, 2020, focusing on the 16-week period around March 16, 2020, which includes 1080 observations. We further analyzed subsets of critical procedures. Results We found a decline in critical procedures by 43% although no critical procedures were postponed by the hospital. Meanwhile, the share of critical procedures increased up to 90% caused by the cancellation of elective surgery. Especially worrisome was that diagnostic procedures for suspected malignancies decreased by 41% during the pandemic. Conclusion The decline in critical procedures in otorhinolaryngology as collateral damage of the COVID-19 pandemic is considerable and therefore alarming.

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“…[20][21][22][23] Amid this intense focus on the tracheotomy procedure, including indications, timing, and technique, far less attention has been afforded to several high-stakes postprocedural considerations. [24][25][26][27][28][29] Many pressing issues came to light only after significant clinical experience of downstream effects of pandemic care-such as occlusion risk due to highly tenacious COVID-19 secretion or bleeding risk from aggressive prophylactic anticoagulation to counteract thrombotic stroke risks in COVID-19. 30,31 Furthermore, many health care workers are still inadequately trained regarding precautions during aerosol-generating procedures (AGPs).…”

mentioning

confidence: 99%

Multidisciplinary Safety Recommendations After Tracheostomy During COVID‐19 Pandemic: State of the Art Review

Meister

Pandian

Hillel

et al. 2020

Otolaryngol.--head neck surg.

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Objective In the chronic phase of the COVID-19 pandemic, questions have arisen regarding the care of patients with a tracheostomy and downstream management. This review addresses gaps in the literature regarding posttracheostomy care, emphasizing safety of multidisciplinary teams, coordinating complex care needs, and identifying and managing late complications of prolonged intubation and tracheostomy. Data Sources PubMed, Cochrane Library, Scopus, Google Scholar, institutional guidance documents. Review Methods Literature through June 2020 on the care of patients with a tracheostomy was reviewed, including consensus statements, clinical practice guidelines, institutional guidance, and scientific literature on COVID-19 and SARS-CoV-2 virology and immunology. Where data were lacking, expert opinions were aggregated and adjudicated to arrive at consensus recommendations. Conclusions Best practices in caring for patients after a tracheostomy during the COVID-19 pandemic are multifaceted, encompassing precautions during aerosol-generating procedures; minimizing exposure risks to health care workers, caregivers, and patients; ensuring safe, timely tracheostomy care; and identifying and managing laryngotracheal injury, such as vocal fold injury, posterior glottic stenosis, and subglottic stenosis that may affect speech, swallowing, and airway protection. We present recommended approaches to tracheostomy care, outlining modifications to conventional algorithms, raising vigilance for heightened risks of bleeding or other complications, and offering recommendations for personal protective equipment, equipment, care protocols, and personnel. Implications for Practice Treatment of patients with a tracheostomy in the COVID-19 pandemic requires foresight and may rival procedural considerations in tracheostomy in their complexity. By considering patient-specific factors, mitigating transmission risks, optimizing the clinical environment, and detecting late manifestations of severe COVID-19, clinicians can ensure due vigilance and quality care.

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Otolaryngology in the Time of Corona: Assessing Operative Impact and Risk During the COVID‐19 Crisis

Cited by 16 publications

References 20 publications

Impact of COVID-19 on Cleft Surgical Care

Impact of COVID-19 on Cleft Surgical Care

Collateral damage of the COVID-19 pandemic: an alarming decline in critical procedures in otorhinolaryngology in a German university hospital

Multidisciplinary Safety Recommendations After Tracheostomy During COVID‐19 Pandemic: State of the Art Review

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