Effects of COVID‐19 on mastectomy and breast reconstruction rates: A national surgical sample

Rubenstein, Robyn; Stern, Carrie S.; Plotsker, Ethan L.; Haglich, Kathryn; Tadros, Audree B; Mehrara, Babak J.; Matros, Evan; Nelson, Jonas A.

doi:10.1002/jso.26889

Cited by 15 publications

(21 citation statements)

References 29 publications

(74 reference statements)

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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%

“…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. Similarly, Chiang et al, 16 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.…”

Section: Discussionsupporting

confidence: 85%

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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: Discussionsupporting

confidence: 85%

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

et al. 2023

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“…Most of the included articles were from high-income countries (HICs) (i.e., n = 38, 76.0% from HICs and n = 12, 24.0% from low- and middle-income countries [LMICs]). Seventeen studies reported on the ‘impact of COVID-19’ [ 25 , 27 , 44 , 47 , 48 , 50 – 52 , 57 , 68 – 73 , 75 ], 30 reported on ‘health system responses, effects or challenges’ [ 6 , 7 , 18 , 21 – 24 , 38 , 40 – 43 , 45 , 46 , 49 , 53 – 56 , 58 – 67 , 74 ] and 3 reported on both [ 5 , 26 , 39 ]. We present the key findings below in a narrative synthesis, according to the primary outcomes ( S1 Checklist ).…”

Section: Resultsmentioning

confidence: 99%

“…The results of three studies of multi-center elective surgical performance reductions [ 44 , 47 , 48 ] and three ecological studies of elective surgical case performance rates [ 50 – 52 ], respectively, are tabulated (Tables 3 and 4 ).…”

Section: Resultsmentioning

confidence: 99%

Global elective breast- and colorectal cancer surgery performance backlogs, attributable mortality and implemented health system responses during the COVID-19 pandemic: A scoping review

Haribhai

Bhatia

Shahmanesh

2023

PLOS Glob Public Health

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Globally, 28.4 million non-emergent (‘elective’) surgical procedures have been deferred during the COVID-19 pandemic. This study evaluated the impact of the COVID-19 pandemic on elective breast- or colorectal cancer (CRC) procedure backlogs and attributable mortality, globally. Further, we evaluated the interaction between procedure deferrals and health systems, internationally. Relevant articles from any country, published between December 2019–24 November 2022, were identified through searches of online databases (MEDLINE, EMBASE) and by examining the reference lists of retrieved articles. We organised health system-related findings thematically per the Structures-Processes-Outcomes conceptual model by Donabedian (1966). Of 337 identified articles, we included 50. Eleven (22.0%) were reviews. The majority of included studies originated from high-income countries (n = 38, 76.0%). An ecological, modelling study elucidated that global 12-week procedure cancellation rates ranged from 68.3%–73%; Europe and Central Asia accounted for the majority of cancellations (n = 8,430,348) and sub-Saharan Africa contributed the least (n = 520,459). The percentage reduction in global, institutional elective breast cancer surgery activity ranged from 5.68%–16.5%. For CRC, this ranged from 0%–70.9%. Significant evidence is presented on how insufficient pandemic preparedness necessitated procedure deferrals, internationally. We also outlined ancillary determinants of delayed surgery (e.g., patient-specific factors). The following global health system response themes are presented: Structural changes (i.e., hospital re-organisation), Process-related changes (i.e., adapted healthcare provision) and the utilisation of Outcomes (i.e., SARS-CoV-2 infection incidence among patients or healthcare personnel, postoperative pulmonary complication incidence, hospital readmission, length of hospital stay and tumour staging) as indicators of health system response efficacy. Evidence on procedure backlogs and attributable mortality was limited, partly due to insufficient, real-time surveillance of cancer outcomes, internationally. Elective surgery activity has decreased and cancer services have adapted rapidly, worldwide. Further research is needed to understand the impact of COVID-19 on cancer mortality and the efficacy of health system mitigation measures, globally.

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“…Various countries have reported a decrease in the number of breast cancer surgeries during the COVID-19 pandemic 8,9,11,19,[23][24][25][26][27] . Additionally, several studies have examined changes in the number according to the type of surgery; however, the results remain inconsistent.…”

Section: Discussionmentioning

confidence: 99%

Impact of coronavirus disease 2019 pandemic on breast cancer surgery using the National Database of Japan

Fujita

Hashimoto²,

Nagashima

et al. 2023

Sci Rep

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Various countries have reported a decrease in breast cancer surgeries during the coronavirus disease 2019 (COVID-19) pandemic; however, inconsistent results have been reported in Japan. This study revealed changes in the number of surgeries during the pandemic using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) from January 2015 to January 2021, where insurance claims data from Japan as a whole are comprehensively accumulated. The number of breast-conserving surgeries (BCS) without axillary lymph node dissection (ALND) significantly decreased in July (− 846; 95% confidence interval (CI) − 1190 to − 502) and October 2020 (− 540; 95% CI − 861 to − 218). No decrease was observed for other types of surgery, BCS with ALND, and mastectomy with or without ALND. In the age-specific subgroup analysis, significant and transient reduction in BCS without ALND was observed in all age groups (0–49, 50–69, and ≥ 70 years). The number of BCS without ALND significantly decreased for a relatively short period in the early pandemic stages, suggesting reduced surgery for patients with a relatively low stage of cancer. Some patients with breast cancer might have been left untreated during the pandemic, and an unfavorable prognosis would be a concern.

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Effects of COVID‐19 on mastectomy and breast reconstruction rates: A national surgical sample

Cited by 15 publications

References 29 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

Global elective breast- and colorectal cancer surgery performance backlogs, attributable mortality and implemented health system responses during the COVID-19 pandemic: A scoping review

Impact of coronavirus disease 2019 pandemic on breast cancer surgery using the National Database of Japan

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