The COVID-19 Pandemic and Plastic Surgery: Literature Review, Ethical Analysis, and Proposed Guidelines

Abstract

Background: Coronavirus disease 2019 (COVID-19), known as the “coronavirus,” has spread to over 170 countries. In response, many organizations have spoken out and called for cancellation of all elective surgical procedures. This study aimed to provide clear recommendations for plastic surgeons to follow by addressing the following issues: (1) What defines elective surgery, and where does one draw the line between essential versus nonessential services? (2) How does this differ in the hospital versus private practice setting? (3) If called on to operate on a patient with COVID-19, how do plastic surgeons protect themselves and still provide excellent medical care? Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review of the literature on plastic surgery in the setting of a pandemic was performed on March 19, 2020. An ethical analysis was conducted using the four principles of medical ethics. Results: The initial search yielded 118 articles. Eighteen articles were relevant and included for analysis. Only one editorial article was published in a plastic surgery journal. Accordingly, no peer-reviewed published COVID-19 guidelines exist for plastic surgery. Given that this pandemic may place health care systems under undue stress with an unpredictable trajectory, it is the responsibility of the plastic surgeon to assess and postpone cases whenever possible to properly contribute to adequate resource allocation and patient safety measures. Conclusions: This article fills an important gap in the literature by addressing COVID-19 and providing guidelines for upholding ethics and responsible resource allocation. By upholding these standards, plastic surgeons can do their part to help minimize the spread of this virus.

Impact of the COVID-19 Pandemic on the Practice of Hand and Upper Extremity Surgeons

“…[6]. Many medical and surgical societies got together and devised various strategies on how to balance the surgical and safety needs of the patients and, despite constraints, how to best manage their resource allocation and contribute to mitigation efforts in place during the pandemic [7][8][9][10][11][12][13].…”

“…Other researchers have studied the effect of the pandemic on many different specialties such as orthopedic surgery, maxillofacial surgery, plastic surgery, minimal access surgery, and transplant surgery [6][7][8][9][10][11][12][13][14][15][16]. However, a comprehensive analysis of the effect of COVID-19 on hand surgery has not been done.…”

Impact of COVID-19 geographic distribution on advanced age plastic surgeons: A cross-sectional analysis

“… 2 Advanced age patients are at increased risk of COVID-19 morbidity and mortality, and represent a potential for nosocomial transmission to healthcare providers. 3

Figure 1 Geospatial distribution of cumulative COVID-19 cases and plastic surgeons age ≥ 60 in the United States. States were grouped into color-coordinated quintiles based on relative proportion of older plastic surgeons, and cumulative COVID-19 case volumes were adjusted via logarithmic scale to create proportionally-sized data points.

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“…Indications for surgery include traumatic/urgent (e.g., facial fractures) and cosmetic (e.g., rhinoplasty) reasons, and both physical examination and subsequent procedures expose plastic surgeons to the patient's airway, with potential transmission of COVID-19 via respiratory and aerosol droplets. 3 Given the surge in COVID-19 cases across the U.S., identifying geographic regions with susceptible physicians may allow for risk stratification, and provide guidelines for predicting and reducing transmission and mortality. 3 In this study, we compared the geographic distribution of US plastic surgeons ≥ 60 years of age to cumulative COVID-19 cases to better inform clinical guidelines.…”

“… 3 Given the surge in COVID-19 cases across the U.S., identifying geographic regions with susceptible physicians may allow for risk stratification, and provide guidelines for predicting and reducing transmission and mortality. 3 In this study, we compared the geographic distribution of US plastic surgeons ≥ 60 years of age to cumulative COVID-19 cases to better inform clinical guidelines.…”