Chronicling the COVID-19 pandemic through the plastic surgery literature

Anesthesiology Articles Published in 2020: A Review and Characterization of COVID-19 Versus Non-COVID-19 Publications in Top Anesthesiology Journals

The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on the practice of medicine worldwide, particularly in anesthesiology. As the clinical realm has rapidly adjusted to the realities of the pandemic, anesthesiology literature has also changed significantly to reflect this. The purpose of this study was to characterize the effects the COVID-19 pandemic has had on anesthesiology literature. Specifically, it was hypothesized that the COVID-19-related literature in the anesthesiology community would gain more interest than non-COVID-19-related articles. A total of 15 anesthesiology-related journals with the highest impact factor in 2019, according to the Journal Citation Reports (JCR), were selected for data collection. An advanced PubMed search identified 5,722 COVID-19-related articles published by these journals in 2020. Next, articles with titles including “corona,” “COVID,” “COVID-19,” “pandemic,” “SARS,” or “SARS-CoV-2” were selected for inclusion in the study, which resulted in 676 (12%) articles. A Kruskal-Wallis test was used to assess the Altmetric score, which is a weighted calculation of the attention an article receives online, for COVID-19 versus non-COVID-19 articles. Articles were then further characterized across multiple different variables, including country of origin, month published, type of article, and subspecialty of anesthesiology it pertained to. Of the 15 journals investigated, 676 (12%) articles of the 5,722 total articles published were found to be COVID-19-related material. The majority of the articles were found to be published in April (18%), May (19.5%), and June (14%). The majority of these articles were related either to general anesthesia (operating room anesthesiology that is not tied to a particular subspecialty fellowship track) (48%) or critical care (39%). By article type, most were determined to be editorial (71%) in nature, followed by original research articles (21%), of which most were cross-sectional (55%) studies. When compared with non-COVID-19-related articles, COVID-19-related articles had a significantly greater Altmetric score (29.518 versus 8.6333, p < 0.001). Of the COVID-19-related articles, original articles had the greatest Altmetric score, when compared to editorials and guidelines (54.794 versus 20.777 versus 40.643, p < 0.002). The response of the academic anesthesiology community to the COVID-19 pandemic was strong and timely, with a particularly strong focus on critical care anesthesia. The impact of the pandemic was strongly felt by the anesthesiology community, and their timely response served to guide our country and world through an incredibly challenging time. The pandemic highlighted the value of anesthesiologists worldwide, not only in the operating room setting but particularly as critical care physicians.

Breast Reconstruction during the COVID-19 Pandemic: A Systematic Review

Introduction

The COVID-19 pandemic posed unique challenges for breast reconstruction. Many professional organizations initially placed restrictions on breast reconstruction, leading surgeons to conceive innovative protocols for offering breast reconstruction. This study reviewed the current evidence on breast reconstruction during the COVID-19 pandemic to provide guidance for surgeons facing future crises.

Methods

The MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews were searched for studies (1) describing implant and autologous breast reconstruction following mastectomy and (2) occurring during or pertaining to the COVID-19 pandemic.

Results

Of the 1347 studies identified, 26 were included. Studies discussed type of reconstruction (18, 69%), complications (11, 42%), timing of reconstruction (10, 38%), protocols (10, 38%), COVID-19 screening (7, 27%), and length of hospital stay (7, 27%). The type of reconstruction varied depending on the stage of the pandemic: early on, autologous breast reconstruction was halted to preserve resources, but was later resumed. Within implant-based reconstruction, direct-to-implant was favored over serial tissue expansion. Several protocols were developed, with many emphasizing multidisciplinary collaborations for patient selection, use of specialized measures to reduce risk of COVID-19 transmission, and optimization of same-day discharge. Complication rates following breast reconstruction were similar to pre-pandemic rates.

Conclusions

The COVID-19 pandemic has forever changed the landscape of breast reconstruction by raising important questions about delivery of care, cost, and resource utilization. The findings of this review may inform surgeons as they plan for similar future crises or strive for improved patient care and efficacy even during nonpandemic times.

Chronicling the effect of COVID-19 on orthopedic literature

Background

The novel coronavirus disease (COVID-19) has had a significant impact on orthopedic surgery practice, but there has been little investigation of the effects of COVID-19 on the orthopedic surgery literature. Additionally, because orthopedic research plays a vital role in physician education, changes to the characteristics and content of published literature can have lasting impacts on future teaching and learning. This paper represents the first known analysis of the COVID-19 pandemic's impact on peer-reviewed articles published in orthopedic surgery journals.

Methods

The 20 orthopedic journals with the highest impact factors in 2019, according to the Journal Citation Reports, were included in this study. Using PubMed and COVID-19 related keywords as well as manual screening, a final count of 199 articles were assessed for this study and subsequently sorted by country of origin, orthopedic subspecialty, article type, and general theme. Kruskal Wallis and Pearson's Chi-squared tests were used to analyze continuous and categorical variables, respectively.

Results

Fourteen journals published articles relating to COVID-19, representing 26 countries with the United States (37%) and United Kingdom (13%) publishing the greatest proportion of all COVID-19 articles. Sixty percent of publications discussed COVID-19's impact on the overall field of orthopedic surgery, with the remainder focusing on specific subspecialties. Forty-seven percent of publications were original research articles while 46% were editorials or commentaries. The median time to publication for all COVID-19 related articles was 24.5 days, compared to the 129 days reported for orthopedic journals prior to the COVID-19 pandemic (p < 0.001). In the first 100 articles published, 49% (n = 49) originated exclusively from United States institutions, whereas only 25% (n = 25) of the next ninety-nine articles had US-only institutions (p < 0.001).

Conclusions

The COVID-19 pandemic has significantly impacted the characteristics, content, and time to publication of the orthopedic surgery literature. The data and ideas presented in this paper should help streamline future, formal analysis on the lasting implications of COVID-19 on orthopedic surgery practice, teaching, and learning.