The Early Effects of Coronavirus Disease-2019 on Head and Neck Oncology and Microvascular Reconstruction Practice: A National Survey of Oral and Maxillofacial Surgeons Enrolled in the Head and Neck Special Interest Group

Abstract

Purpose The coronavirus disease-2019 (COVID-19) pandemic has affected healthcare systems across the nation. The purpose of this study is to gauge the early effects of the COVID-19 pandemic on head and neck oncology and reconstructive surgery (HNORS) practice and evaluate their practice patterns especially ones that might be impacted by COVID-19 and compare them to the current literature. Methods This study is a cross-sectional study that surveyed fellowship-trained oral and maxillofacial surgeons in HNORS. This cohort of surgeons was contacted via a generated email list of surgeons enrolled in the American Association of Oral and Maxillofacial Surgeons pathology special interest group. An electronic survey contained 16 questions to assess the COVID-19 effect on HNORS practice and capture their practice patterns from mid-March to mid-April 2020. Statistical analysis was performed to analyze counts, percentages, and response rates. Results We had a 60% response rate (39 of 64); 72% of our responders worked at academic institutions, 18% marked themselves as hybrid academic/private practice, and only 10% were considered hospital-based surgeons. Only 8% of the survey respondents were requested to pause head and neck cancer surgery, whereas 24% were requested to pause free flap surgery during the pandemic. Fifty-five percent agreed that the head and neck and reconstructive surgery should be conducted during a pandemic. Finally, 45% thought that two weeks was a reasonable delay for head and neck cancer cases, whereas 29% thought they should not be delayed for any amount of time. Regarding practice patterns, microvascular reconstruction was the favored method (100%). Respondents generally admitted patients to an intensive care unit postoperatively (92%) and were kept on a ventilator (53%). Conclusion The COVID-19 pandemic had a small impact on the surgical treatment of patients with head and neck oncology. Most HNORS surgeons are practicing in accordance with recently published literature.

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

“…Microvascular reconstruction continues to be the standard of care at a few centres with adequate resources. However, pedicled flaps being the work-horse can be considered in present circumstances where patients may be managed outside an intensive or high dependency unit with rapid turnover [ 22 ].…”

Cirugía de cabeza y cuello durante la pandemia de COVID-19 en Colombia: Experiencia de un centro de excelencia

“…El número de procedimientos quirúrgicos también sufrió una caída, aunque la variación dependió del país, el tipo de práctica y el momento de la pandemia 17,18 . La estrategia desarrollada permitió que esta diminución no fuera tan dramática, lo que contrasta con reportes de supresión de casi el 100 % de la practica quirúrgica en hasta el 17 % de los servicios 18 .…”

Immediate postoperative care on high dependency unit or ward following microvascular free tissue transfer: lessons learnt from a change in practice imposed during the COVID-19 pandemic

“…[1] A national survey of Oral and Maxillofacial surgeons on early effects of the pandemic on head and neck oncology and microvascular reconstruction practice reported that 8% were requested to pause head and neck cancer (HNC) surgery, 24% to pause free flap surgery, while 55% agreed that head and neck and reconstructive surgery should continue. [2] Jeannon reported their units continued provision of complex HNC surgery during the pandemic, focused on a two-month period and comprising only 13 patients with microvascular free tissue transfer who were highly selected as low-risk candidates. [3] In our Unit, the pandemic caused difficulties accessing theatres but contingencies allowed for cancer ablative surgery and free flap reconstruction to continue.…”

“…Interestingly Zaid reported that most surgeons (92%) kept their patients in an intensive care unit (ICU) environment, whereas only 8% transferred them to a specialized step-down unit. [2] …”