The impact of the COVID‐19 pandemic on alloplastic breast reconstruction: An analysis of national outcomes

Chiang, Sarah N; Finnan, Michael J; Skolnick, Gary B.; Sacks, Justin M.; Christensen, James H.

doi:10.1002/jso.26883

Cited by 6 publications

(8 citation statements)

References 47 publications

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“…Prepandemic studies 13,14 have shown no increase in short-term complications, including readmissions and reoperations, after same-day discharge in patients who underwent mastectomy (with and without implant reconstruction). Two recently published ACS-NSQIP studies 15,16 have also examined the impact of COVID-19 on breast cancer surgery, with findings that corroborate our own. Rubenstein et al 15 found that rates of same-day discharge increased from 2019 to 2020 for patients who underwent mastectomy with alloplastic, but not autologous reconstruction.…”

Section: Discussionsupporting

confidence: 85%

“…Rubenstein et al found that rates of same-day discharge increased from 2019 to 2020 for patients who underwent mastectomy with alloplastic, but not autologous reconstruction. Similarly, Chiang et al, who only included patients undergoing alloplastic reconstruction, found an increased rate of outpatient cases in 2020 and did not observe an increased risk of complications compared with inpatient cases. While our study did not stratify patients undergoing mastectomy based on the presence and type of reconstruction, it is likely that very few patients discharged on postoperative day 0 underwent autologous reconstruction, as these patients are typically admitted to hospital for flap monitoring after surgery.…”

Section: Discussionmentioning

confidence: 95%

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Performance of General Surgical Procedures in Outpatient Settings Before and After Onset of the COVID-19 Pandemic

et al. 2023

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ImportanceThe American College of Surgeons (ACS) has advocated for the expansion of outpatient surgery to conserve limited hospital resources and bed capacity, while maintaining surgical throughput, during the COVID-19 pandemic.ObjectiveTo investigate the association of the COVID-19 pandemic with outpatient scheduled general surgery procedures.Design, Setting, and ParticipantsThis multicenter, retrospective cohort study analyzed data from hospitals participating in the ACS National Surgical Quality Improvement Program (ACS-NSQIP) from January 1, 2016, to December 31, 2019 (before COVID-19), and from January 1 to December 31, 2020 (during COVID-19). Adult patients (≥18 years of age) who underwent any 1 of the 16 most frequently performed scheduled general surgery operations in the ACS-NSQIP database were included.Main Outcomes and MeasuresThe primary outcome was the percentage of outpatient cases (length of stay, 0 days) for each procedure. To determine the rate of change over time, multiple multivariable logistic regression models were used to assess the independent association of year with the odds of outpatient surgery.ResultsA total of 988 436 patients were identified (mean [SD] age, 54.5 [16.1] years; 574 683 women [58.1%]), of whom 823 746 underwent scheduled surgery before COVID-19 and 164 690 had surgery during COVID-19. On multivariable analysis, the odds of outpatient surgery during COVID-19 (vs 2019) were higher in patients who underwent mastectomy for cancer (odds ratio [OR], 2.49 [95% CI, 2.33-2.67]), minimally invasive adrenalectomy (OR, 1.93 [95% CI, 1.34-2.77]), thyroid lobectomy (OR, 1.43 [95% CI, 1.32-1.54]), breast lumpectomy (OR, 1.34 [95% CI, 1.23-1.46]), minimally invasive ventral hernia repair (OR, 1.21 [95% CI, 1.15-1.27]), minimally invasive sleeve gastrectomy (OR, 2.56 [95% CI, 1.89-3.48]), parathyroidectomy (OR, 1.24 [95% CI, 1.14-1.34]), and total thyroidectomy (OR, 1.53 [95% CI, 1.42-1.65]). These odds were all greater than those observed for 2019 vs 2018, 2018 vs 2017, and 2017 vs 2016, suggesting that an accelerated increase in outpatient surgery rates in 2020 occurred as a consequence of COVID-19, rather than a continuation of secular trends. Despite these findings, only 4 procedures had a clinically meaningful (≥10%) overall increase in outpatient surgery rates during the study period: mastectomy for cancer (+19.4%), thyroid lobectomy (+14.7%), minimally invasive ventral hernia repair (+10.6%), and parathyroidectomy (+10.0%).Conclusions and RelevanceIn this cohort study, the first year of the COVID-19 pandemic was associated with an accelerated transition to outpatient surgery for many scheduled general surgical operations; however, the magnitude of percentage increase was small for all but 4 procedure types. Further studies should explore potential barriers to the uptake of this approach, particularly for procedures that have been shown to be safe when performed in an outpatient setting.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 95%

Performance of General Surgical Procedures in Outpatient Settings Before and After Onset of the COVID-19 Pandemic

et al. 2023

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“…Indeed, a comparison of protocols before, during, and after the COVID‐19 pandemic among 357 patients done by Olimpiadi et al revealed a tripling of outpatient mastectomies and increased use of pectoralis muscle blocks 13 . Among alloplastic reconstruction in particular, COVID‐19 prompted an increase in delayed reconstruction and increased outpatient surgeries 14 …”

Section: Discussionmentioning

confidence: 99%

“…13 Among alloplastic reconstruction in particular, COVID-19 prompted an increase in delayed reconstruction and increased outpatient surgeries. 14 Analysis of complications and outcomes among smaller patient cohorts showed no difference between patients who underwent same-day surgery versus those admitted for observation, [15][16][17][18] which has been supported by aggregate data from larger databases and systematic reviews. [19][20][21][22] The data from our patient cohort further reinforces the safety of same-day discharge after mastectomy and alloplastic reconstruction, whereby no significant increase in complication rate was seen after the institution of an ERAS protocol.…”

Section: F I G U R E 1 Flow Diagram Of Group Divisions Of Included Pa...mentioning

confidence: 91%

Safety and factors affecting same‐day discharge following mastectomy and immediate alloplastic reconstruction

Ghosh,

Shakir,

Kuchta

et al. 2023

Journal of Surgical Oncology

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Background and ObjectivesPatients undergoing breast reconstruction following mastectomy are often admitted overnight. In 2020, our institution implemented a protocol change to discharge clinically stable patients immediately. In this study, we examine the safety of same‐day discharge following mastectomy and reconstruction.MethodsOur retrospective study included female adults undergoing mastectomy and immediate alloplastic reconstruction from August 2019 to January 2020, before implementation of the same‐day discharge protocol, and from March 2020 to September 2021, after the protocol implementation. Independent t‐test and chi‐square analysis was conducted to examine statistical differences.ResultsTwo hundred and eighty‐five patients were included. Forty‐two patients underwent reconstruction before the protocol change (Group 1) and 243 patients underwent reconstruction after the protocol change (Group 2). Group 2 had a greater percentage of prepectoral implant placement. There was no difference in demographics, complications, readmission, or reoperation. Within Group 2, 157 patients were discharged the same day (Group 2a) and 88 patients required overnight admission (Group 2b). Group 2b had higher body mass index, higher percentage of bilateral mastectomy, and larger mastectomy weights. Despite no differences in complications, Group 2b exhibited higher rates of requiring intravenous antibiotics and reoperation.ConclusionsPatients may be safely discharged the same day following mastectomy and alloplastic reconstruction without an increase in complications.

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“…Studies on implant-and tissue expander-based reconstruction suggests that COVID-19 is not an independent risk factor for postoperative complications, but the same cannot be generalized to autologous reconstruction. 10 Although early work has indicated that the pandemic did not significantly affect 30-day outcomes in autologous flap reconstruction, there was a notable decrease in the proportion of autologous breast reconstruction cases, compared with other types of flaps, and studies with larger patient numbers are needed to make stronger associations. We therefore decided to undertake this study with a large international database to elucidate whether a prior history of COVID-19 affects outcomes in autologous breast reconstruction.…”

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confidence: 99%

Prior COVID-19 Infection Predisposes to Worse Outcomes After Autologous Breast Reconstruction

et al. 2023

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Background Major shifts in health care systems worldwide have occurred because of coronavirus disease 2019 (COVID-19). With nearly half of all Americans now having a history of COVID-19 infection, there is a pressing need to better understand the importance of prior COVID-19 infection as a potential surgical risk factor. The aim of this study was to investigate the impact of a history of prior COVID-19 infection on patient outcomes after autologous breast reconstruction. Methods We performed a retrospective study using the TriNetX research database, which contains deidentified patient records from 58 participating international health care organizations. All patients who underwent autologous breast reconstruction between March 1, 2020, and April 9, 2022, were included and were grouped based on history of a prior COVID-19 infection. Demographic, preoperative risk factors, and 90-day postoperative complication data were compared. Data were analyzed by propensity score–matched analysis on TriNetX. Statistical analyses were performed by Fisher exact, χ2, and Mann-Whitney U tests as appropriate. Significance was set at P values of <0.05. Results Patients with a history of autologous breast reconstruction within our temporal study window (N = 3215) were divided into groups with (n = 281) and without (n = 3603) a prior COVID-19 diagnosis. Nonmatched patients with prior COVID-19 had increased rates of select 90-day postoperative complications, including wound dehiscence, contour deformities, thrombotic events, any surgical site complications, and any complications overall. Use of anticoagulant, antimicrobial, and opioid medications was also found to be higher in those with prior COVID-19. After performing propensity-score matching, each cohort consisted of 281 patients without statistically significant differences between any baseline characteristics. When comparing outcomes between matched cohorts, patients with a history of COVID-19 had increased rates of wound dehiscence (odds ratio [OR], 1.90; P = 0.030), thrombotic events (OR, 2.83; P = 0.0031), and any complications (OR, 1.52; P = 0.037). Conclusions Our results suggest that prior COVID-19 infection is a significant risk factor for adverse outcomes after autologous breast reconstruction. Patients with a history of COVID-19 have 183% higher odds of postoperative thromboembolic events, warranting careful patient selection and postoperative management.

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The impact of the COVID‐19 pandemic on alloplastic breast reconstruction: An analysis of national outcomes

Cited by 6 publications

References 47 publications

Performance of General Surgical Procedures in Outpatient Settings Before and After Onset of the COVID-19 Pandemic

Performance of General Surgical Procedures in Outpatient Settings Before and After Onset of the COVID-19 Pandemic

Safety and factors affecting same‐day discharge following mastectomy and immediate alloplastic reconstruction

Prior COVID-19 Infection Predisposes to Worse Outcomes After Autologous Breast Reconstruction

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