Breast reconstruction during the COVID-19 pandemic: Single institution experience from the pandemic's epicenter in the United States

Boyd, Carter J.; Hemal, Kshipra; Ramesh, Sruthi; Bekisz, Jonathan M.; Salibian, Ara A.; Thanik, Vishal; Levine, Jamie P.; Choi, Mihye; Karp, Nolan S.

doi:10.1016/j.bjps.2022.02.021

Cited by 7 publications

(8 citation statements)

References 12 publications

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“…Studies showing no tumor shift, as displayed in the presented results, are scarce, 11,15 but may also have been underreported. Our study showed no difference in terms of frequency and modalities of breast reconstruction surgery in 2020 compared to 2019, unlike other studies that found less breast reconstruction surgeries post‐pandemic, in consistence with scientific recommendations 15,50–53 …”

Section: Discussionsupporting

confidence: 62%

Impact of the COVID‐19 pandemic on clinical presentation, treatments, and outcomes of new breast cancer patients: A retrospective multicenter cohort study

Guével,

Priou,

Lamé

et al. 2023

Cancer Medicine

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BackgroundThe SARS CoV‐2 pandemic disrupted healthcare systems. We compared the cancer stage for new breast cancers (BCs) before and during the pandemic.MethodsWe performed a retrospective multicenter cohort study on the data warehouse of Greater Paris University Hospitals (AP‐HP). We identified all female patients newly referred with a BC in 2019 and 2020. We assessed the timeline of their care trajectories, initial tumor stage, and treatment received: BC resection, exclusive systemic therapy, exclusive radiation therapy, or exclusive best supportive care (BSC). We calculated patients' 1‐year overall survival (OS) and compared indicators in 2019 and 2020.ResultsIn 2019 and 2020, 2055 and 1988, new BC patients underwent cancer treatment, and during the two lockdowns, the BC diagnoses varied by −18% and by +23% compared to 2019. De novo metastatic tumors (15% and 15%, p = 0.95), pTNM and ypTNM distributions of 1332 cases with upfront resection and of 296 cases with neoadjuvant therapy did not differ (p = 0.37, p = 0.3). The median times from first multidisciplinary meeting and from diagnosis to treatment of 19 days (interquartile 11–39 days) and 35 days (interquartile 22–65 days) did not differ. Access to plastic surgery (15% and 17%, p = 0.08) and to treatment categories did not vary: tumor resection (73% and 72%), exclusive systemic therapy (13% and 14%), exclusive radiation therapy (9% and 9%), exclusive BSC (5% and 5%) (p = 0.8). Among resected patients, the neoadjuvant therapy rate was lower in 2019 (16%) versus 2020 (20%) (p = 0.02). One‐year OS rates were 99.3% versus 98.9% (HR = 0.96; 95% CI, 0.77–1.2), 72.6% versus 76.6% (HR = 1.28; 95% CI, 0.95–1.72), 96.6% versus 97.8% (HR = 1.09; 95% CI, 0.61–1.94), and 15.5% versus 15.1% (HR = 0.99; 95% CI, 0.72–1.37), in the treatment groups.ConclusionsDespite a decrease in the number of new BCs, there was no tumor stage shift, and OS did not vary.

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Section: Discussionsupporting

confidence: 62%

Impact of the COVID‐19 pandemic on clinical presentation, treatments, and outcomes of new breast cancer patients: A retrospective multicenter cohort study

Guével,

Priou,

Lamé

et al. 2023

Cancer Medicine

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“… 55 , 56 However, Boyd et al reported a lower reduction in mammogram activities (11%) initially coupled with a quick return to normal and even an increase (15%) in patients presenting between October to December 2020 versus pre-pandemic levels. 57 Cairns et al also documented a significant decrease in the number of screening mammograms (44% reduction) and diagnostic mammograms (21% reduction) following lockdown measures in 2020 versus a similar period in 2019. However, they found no significant difference in the number of operations for new breast cancer patients in 2020 versus 2019.…”

Section: Resultsmentioning

confidence: 97%

“… 66 Yin et al in the USA also documented a weekly decline of 20.5% in surgical procedures versus pre-pandemic levels, with Boyd et al documenting breast cancer surgeries declining by 6.8% in the first wave with the level of breast reconstruction surgery also declining. 57 , 66 However, Cairns et al in the USA reported no statistically significant difference in the number of breast cancer operations for new patients during the first wave of the pandemic versus pre-pandemic levels. 58 …”

Section: Resultsmentioning

confidence: 99%

Breast Cancer Management in the Era of Covid-19; Key Issues, Contemporary Strategies, and Future Implications

Prodhan

Islam

Khandker

et al. 2023

BCTT

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During the COVID-19 pandemic, several priority diseases were not getting sufficient attention. Whilst breast cancer is a fatal disease affecting millions worldwide, identification and management of these patients did not initially attract critical attention to minimize the impact of lockdown, post-lockdown, and other measures. Breast cancer patients’ conditions may not remain stable without proper care, worsening their prognosis. Proper care includes the timely instigation of surgery, systemic therapy, and psychological support. This includes low-and middle-income countries where there are already concerns with available personnel and medicines to adequately identify and treat these patients. Consequently, there was a need to summarize the current scenario regarding managing breast cancer care during COVID-19 across all countries, including any guidelines developed. We systematically searched three scientific databases and found 76 eligible articles covering the medical strategies of high-income countries versus LMICs. Typically, diagnostic facilities in hospitals were affected at the beginning of the pandemic following the lockdown and other measures. This resulted in more advanced-stage cancers being detected at initial presentation across countries, negatively impacting patient outcomes. Other than increased telemedicine, instigating neo-adjuvant endocrine therapy more often, reducing non-essential visits, and increasing the application of neo-adjuvant chemotherapy to meet the challenges, encouragingly, there was no other significant difference among patients in high-income versus LMICs. Numerous guidelines regarding patient management evolved during the pandemic to address the challenges posed by lockdowns and other measures, which were subsequently adopted by various high-income countries and LMICs to improve patient care. The psychological impact of COVID-19 and associated lockdown measures, especially during the peak of COVID-19 waves, and the subsequent effect on the patient’s mental health must also be considered in this high-priority group. We will continue to monitor the situation to provide direction in future pandemics.

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“…However, as case volumes rise for patients with a history of COVID-19, more data have become available for analysis of this topic. Early single institution studies have provided preliminary insight into the impact of COVID-19 on postoperative outcomes 14–16 . In the field of breast reconstruction, independent reports from the United States and abroad demonstrated similar complications during the pandemic when compared with prepandemic times, although small sample sizes of COVID positive patients likely limited the scope of such analyses 17 .…”

Section: Discussionmentioning

confidence: 99%

“…Early single institution studies have provided preliminary insight into the impact of COVID-19 on postoperative outcomes. [14][15][16] In the field of breast reconstruction, independent reports from the United States and abroad demonstrated similar complications during the pandemic when compared with prepandemic times, although small sample sizes of COVID positive patients likely limited the scope of such analyses. 17 The use of large national and international databases by different medical institutions has allowed deep investigation into how patients with prior COVID-19 infection may experience different outcomes for various surgical procedures.…”

Section: Discussionmentioning

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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Breast reconstruction during the COVID-19 pandemic: Single institution experience from the pandemic's epicenter in the United States

Cited by 7 publications

References 12 publications

Impact of the COVID‐19 pandemic on clinical presentation, treatments, and outcomes of new breast cancer patients: A retrospective multicenter cohort study

Impact of the COVID‐19 pandemic on clinical presentation, treatments, and outcomes of new breast cancer patients: A retrospective multicenter cohort study

Breast Cancer Management in the Era of Covid-19; Key Issues, Contemporary Strategies, and Future Implications

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

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