Head and Neck Surgery During COVID-19 Pandemic: Experience from a Tertiary Care in India

Abstract

Head and neck pathologies requiring surgical intervention are considered a high-risk subsite in the context of COVID-19 pandemic by virtue of its close proximity to the mucosa of the upper aerodigestive tract. Retrospective review of all head and neck surgical procedures is undertaken during the pandemic from 23rd April 2020 to 30th September 2020. One hundred procedures were performed on 98 patients. COVID-19 status determined by SARS-Cov-2 RT-PCR at baseline was negative for 81, positive in 8 and unknown in 11. The RT-PCR negative subgroup included 40 diagnostic procedures and 41 ablative and or reconstructive procedures for head and neck neoplasms. None of the patients or health-care workers converted to COVID-19-positive status during the duration of the hospital stay. There were no cases with 30-day mortality. Clavien-Dindo grading for postoperative complications was as follows: 1–4, 2–12, 3a-2, 3b-1. Eleven patients with unknown COVID-19 status at baseline underwent emergency tracheostomy in a COVID-19 designated operating room for upper airway obstruction secondary to head and neck cancer. Of the 8 procedures conducted on known cases of COVID-19, 6 were tracheostomies performed for COVID-19 ARDS. The rest were maxillectomy for acute invasive mucormycosis and incision and drainage for parotid abscess. A matched-pair analysis was performed with similarly staged historical cohort operated during January to December 2016 to compare peri-operative complication rates (Clavien-Dindo Score). Incidence of complication with higher Clavien Dindo Score (>/=3a) was found to be lower in those patients operated during the pandemic (p=0.007). By meticulous preoperative COVID-19 screening and isolation, head and neck surgical procedures can be continued to avoid delay in diagnosis and treatment without jeopardising the risk of transmission of COVID-19 to the patients or health-care workers.

Surgical Protocols before and after COVID-19—A Narrative Review

“…Above all, these trials reported no claims for any COVID-19 screenings or prevention strategies. Panda et al [ 41 ] discovered that the application of the protection strategies led to a reduction in the post-operative problems both at times before and after the pandemic, as well as a decreased rate in the complications in a matched pair analysis.…”

The comparison of Post-Operative Complications pre Covid era versus during Covid-Era based on Clavien-Dindo-classification: A Systematic Review and Meta-Analysis

“…Above all, these studies did not claim any specific screening or preventing protocols for COVID -19. In contrast, with the use of protection protocols, Panda et al found a significant decrease in major post-operative complications during pandemic, and in a matched pair analysis, lower rate of complications (30). Evidence suggests that surgery care can be continued with adopting preventive strategies and protocols, even in the COVID -19 peak (23,(26)(27)(28)(29)42,49,54).…”

“…Using experienced physician to avoid exposure of junior doctors and shorten the duration of procedures (23,30,41,42,47,49,53) Self-isolation Asking patient to be selfisolate (14 days) prior to planned time of surgery (25,32,53,33,35,37,38,41,43,47,48) PCR: Polymerase chain reaction, CT: Computed tomography scan, CXR: Chest X-ray.…”