Estimated National and Regional Impact of COVID-19 on Elective Case Volume in Aesthetic Plastic Surgery

The Impact of the COVID-19 Pandemic on Ophthalmology Residency and Fellowship Training: A Retrospective Study

Background The COVID-19 pandemic has negatively affected many aspects of the healthcare system. Many meta-analysis studies showed that surgical training and medical education have faced the most negative effects. Aim In this study, we aim to study the impact of the COVID-19 pandemic on residency and fellowship training in terms of clinical load, surgical exposure, medical education, and research opportunities. Methodology This retrospective study was conducted at King Khaled Eye Specialist Hospital (KKESH), Riyadh, Saudi Arabia, to assess the effects of COVID-19 on the training program by comparing the years 2018 and 2019 before the COVID-19 pandemic to 2020 and 2021 after the COVID-19 pandemic. The sample was inclusive, including 117 KKESH graduates (residents and fellows in the surgical subspecialties) from 2018 to 2021. All the sample populations were included. The data was collected in a specifically designed form. All participants were ensured to have a full surgical logbook with no missing data in the documentation. Outpatient visits were collected through electronic records in the hospital registry. The teaching activities and grand rounds were collected through the residency and fellowship program. Results During 2018-2021, 18,669 surgeries were performed. The total number of surgeries performed was 3,980, 4,898, 4,813, and 4,978 in 2018, 2019, 2020, and 2021, respectively. There was a 23.1% (N = 918) increase in the number of surgeries done by trainees from 2018 to 2019, then a 1.7% (N = 85) reduction from 2019 to 2020, followed by an increase of 3.4% (N = 165) from 2020 to 2021. The mean number of surgeries performed by fellows showed a 25.2% (N = 1,042) increase from 2018 to 2019, a 7.3% (N = 107) reduction from 2019 to 2020, and a 15.1% (N = 550) increase (p = 0.018). In the case of residents, there was a 10.7% (N = 136) reduction from 2018 to 2019, a 2.1% (N = 24) increase from 2019 to 2020, and a 40% (N = 783) reduction in the total number of phacoemulsification surgeries (p < 0.001).In total, there was a 25.1% (N = 8,215) increase in the number of patients seen in outpatient clinics from 2019 to 2020. All activities were on-site during 2018 and 2019. A gradual shift occurred from on-site to virtual over 2020 and 2021 without any effect on the number. From 2019 to 2020, there was an increase in the number of papers submitted by the trainees. There was an increase of 25% (N = 10), 20% (N = 2), and 6.3% (N = 3) in the retrospective research, prospective research, and case reports, respectively. Conclusions The surgical exposure has not affected the fellows and residents of the hospital. However, the number of surgeries for the residents has been affected due to the stoppage of overseas surgical courses during the pandemic. The volume of the outpatient clinic has increased after the pandemic, which could be caused by the increased number of referrals to our tertiary hospital, mainly after the pandemic effect on other hospitals in the kingdom and the implementation of the virtual clinic and telephone call. Interestingly, research activity has also increased after the pandemic.

The Impact of COVID-19 on Plastic Surgery Residents Across the World: A Country-, Region-, and Income-level Analysis

BACKGROUND

The COVID-19 pandemic has upended graduate medical education globally. We investigated the COVID-19 impact on learning inputs and expected learning outputs of plastic surgery residents across the world.

METHODS

We administered an online survey capturing training inputs before and during the pandemic and retrieved residents' expected learning outputs compared with residents who completed their training before COVID. The questionnaire reached residents across the world through the mobilization of national and international societies of plastic surgeons.

RESULTS

The analysis included 412 plastic surgery residents from 47 countries. The results revealed a 44% decline (ranging from - 79 to 10% across countries) and an 18% decline (ranging from - 76 to across 151% countries) in surgeries and seminars, respectively, per week. Moreover, 74% (ranging from 0 to 100% across countries) and 43% (ranging from 0 to 100% across countries) of residents expected a negative COVID-19 impact on their surgical skill and scientific knowledge, respectively. We found strong correlations only between corresponding input and output: surgeries scrubbed in with surgical skill (ρ = -0.511 with p < 0.001) and seminars attended with scientific knowledge (ρ = - 0.274 with p = 0.006).

CONCLUSIONS

Our ranking of countries based on their COVID-19 impacts provides benchmarks for national strategies of learning recovery. Remedial measures that target surgical skill may be more needed than those targeting scientific knowledge. Our finding of limited substitutability of inputs in training suggests that it may be challenging to make up for lost operating room time with more seminars. Our results support the need for flexible training models and competency-based advancement.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Trend of Academic Productivity in Plastic Surgery and the Impact of COVID-19: A Bibliometric Analysis

BACKGROUND

Plastic surgery has grown rapidly over the past decade, with increasing scientific output. The emergence of coronavirus disease 2019 (COVID-19) has a considerable impact on plastic surgery.

OBJECTIVE

To identify trends in published literature in plastic surgery from 2011 to 2021. To explore the impact of COVID-19 on scientific research output through bibliometric analysis methods.

METHODS

Web of Science was searched by authors on December 23, 2021. Published papers about plastic surgery over the last decade were analyzed. The search output was imported into VOSviewer for science mapping.

RESULTS

The actual number of papers related to plastic surgery during the COVID-19 period was higher than expected one. For scientific outputs in plastic surgery, keywords about surgical practice had a high frequency. "Reconstruction," "effect," "flap," "tissue," "defect," "model" maintained a high level of heat before and after COVID-19. The heat of "risk," "complication," "review," "infection," "cohort," and "meta-analysis" increased after the outbreak of COVID-19. The international collaboration showed an upward trend despite the impact of COVID-19. From the perspective of the volume of plastic surgery publications, some journals had a more positive performance compared to the pre-epidemic period. The proportion of original articles decreased after the spread of COVID-19 from 70.26% to 63.84%.

CONCLUSION

Although the COVID-19 has a profound impact on the healthcare industry, the bibliographic data reveals an increasing scientific output in the field of plastic surgery over time. For plastic surgery, high-frequency terms, research hotspots, popular journals, article types, and international collaboration have changed under the influence of COVID-19.

Impact of Pandemic Response on Training Experience of Anesthesiology Residents in an Academic Medical Center: A Retrospective Cohort Study

Background The impact of the coronavirus disease 2019 (COVID-19) pandemic substantially altered operations at hospitals that support graduate medical education. We examined the impact of the pandemic on an anesthesiology training program with respect to overall case volume, subspecialty exposure, procedural skill experience, and approaches to airway management. Methods Data for this single center, retrospective cohort study came from an Institutional Review Board approved repository for clinical data. Date ranges were divided into the following phases in 2020: Pre-Pandemic (PP), Early Pandemic (EP), Recovery 1 (R1), and Recovery 2 (R2). All periods were compared to the same period from 2019 for case volume, anesthesia provider type, trainee exposure to Accreditation Council for Graduate Medical Education (ACGME) index case categories, airway technique, and patient variables. Results 15,087 cases were identified, with 5,598 (37.6%) in the PP phase, 1,570 (10.5%) in the EP phase, 1,451 (9.7%) in the R1 phase, and 6,269 (42.1%) in the R2 phase. There was a significant reduction in case volume during the EP phase compared to the corresponding period in 2019 (-55.3%; P < .001) that improved but did not return to baseline by the R2 phase (-17.6%; P < .001). ACGME required minimum cases were reduced during the EP phase compared to 2019 data for pediatric cases (age < 12 y, -72.1%; P < .001 and age < 3 y, -53.5%; P < .006) and cardiopulmonary bypass cases (52.3%, P < .003). Surgical subspecialty case volumes were significantly reduced in the EP phase except for transplant surgery. By the R2 phase, all subspecialty volumes had recovered except for plastic surgery (14.9 vs. 10.5 cases/week; P < .006) and surgical endoscopy (59.2 vs. 40 cases/week; P < .001). Use of video laryngoscopy (VL) and rapid sequence induction and intubation (RSII) also increased from the PP to the EP phase (24.6 vs. 79.6%; P < .001 and 10.3 vs. 52.3%; P < .001, respectively) and remained elevated into the R2 phase (35.2%; P < 0.001 and 23.1%; P < .001, respectively). Conclusions The COVID-19 pandemic produced significant changes in surgical case exposure for a relatively short period. The impact was short-lived, with sufficient remaining time to meet the annual ACGME program minimum case requirements and procedural experiences. The longer-term impact may be a shift towards the increased use of VL and RSII, which became more prevalent during the early phase of the pandemic.

The impact of the COVID-19 pandemic on surgical education: A survey and narrative review

Background

Since the emergence of the COVID-19 pandemic, medical education has been a concerning issue, especially in surgical fields. Due to the postponement of many elective surgeries and even alternations in the pattern of emergent surgeries, concerns have been raised about whether residents of surgical disciplines are experienced enough after graduation or not. We aimed to describe the impact of the COVID-19 pandemic on surgical residency training in different fields.

Materials and methods

We conducted a cross-sectional study with a 20-item questionnaire on residents of surgical disciplines from three different educational hospitals of Tehran University of Medical Sciences, Iran in 2020. In addition, we reviewed the current literature regarding the impact of COVID-19 pandemic on surgical education worldwide.

Results

Our survey, with a response rate of 56.8% demonstrated significant reduction in the time spent in elective surgeries, surgical clinics and even in emergent surgeries for residents. Besides, it has reported that significant time has been spent in COVID 19 wards which resulted in decreased satisfaction of educational activities.

Conclusions

The impacts of COVID 19 pandemic on surgical education are significant and inevitable. Thus, we must integrate novel educational methods in surgical curriculum to optimize training and minimize the adverse effects of the pandemic on surgical education.

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The impacts of COVID 19 on surgical education are significant and inevitable.

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We must integrate novel educational methods in surgical curriculum.

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We need to optimize training and minimize the adverse effects of the pandemic.

A Nationwide Study on the Impact of COVID-19 Pandemic on Volume of Spine Surgery in South Korea

OBJECTIVE

In March 2020, World Health Organization declared a global pandemic caused by a novel coronavirus (SARS-CoV-2). The disease caused by this virus is called COVID-19. Due to its high contagiousness, many changes have occurred in overall areas of our daily life including hospital use by patients. The aim of this study was to investigate the impact of COVID-19 on volume of spine surgery in South Korea using the National Health Insurance database and compare it with the volume of a homologous period before the pandemic.

METHODS

Data of related to spine surgery from January 2019 to April 2021 were obtained from the National Health Insurance and Health Insurance Review and Assessment Service database. Primary outcomes were total number of patients, rate of patients per 100000 population, and total number of procedures. The number of patients by hospital size was also analyzed.

RESULTS

COVID-19 outbreaks occurred in South Korea in March, August, and December of 2020. Compared to the previous year, the total number of patients who underwent spinal surgery showed a decrease for 2-3 months after the first and second outbreaks. However, it showed an increasing trend after the third outbreak. The same pattern was observed in terms of the ratio of the number of patients per 100000 population. Between 2019 and 2021, the mean number of spine surgeries per month tended to increase. Mean annual medical expenses increased over the years (p=0.001). When the number of spine surgeries was analyzed by hospital size, proportion of tertiary general hospital in 2021 increased compared to those in 2019 and 2020 (vs. 2019, p=0.012; vs. 2020, p=0.016). The proportion of general hospital was significantly decreased in 2020 compared to that in 2019 (p=0.037).

CONCLUSION

After the COVID-19 outbreak, patients tended to postpone spinal surgery temporarily. The number of spinal surgeries decreased for 2-3 months after the first and second outbreaks. However, as the ability to respond to the COVID-19 pandemic at the hospital and society-wide level gradually increased, the number of spine surgeries did not decrease after the third outbreak in December 2020. In addition, the annual number of spine surgeries continued to increase. However, it should be noted that patients tend to be increasingly concentrated in tertiary hospitals for spinal surgery.

Changes in Burn Surgery Operative Volume and Metrics due to COVID-19

Due to COVID-19, hospitals underwent drastic changes to operating room policy to mitigate the spread of the disease. Given these unprecedented measures, we aimed to look at the changes in operative volume and metrics of the burn surgery service at our institution. A retrospective review was conducted for operative cases and metrics for the months of March to May for 2019, 2020, and 2021, which correspond with pre-COVID, early COVID (period without elective cases), and late COVID (period with resumed elective cases). Inclusion criteria were cases related to burns. Case types and operative metrics were compared amongst the three time periods. Compared to the hospital, the burn service had a smaller decrease in volume during early COVID (28.7% vs. 50.1%) and exceeded pre-pandemic volumes during late COVID (+21.8% vs. -4.6%). There was a significant increase in excision and grafting cases in early and late COVID periods (p < .0001 and p < .002). There was a significant decrease in laser scar procedures that persisted even during late COVID (p < .0001). The projected and actual lengths of cases significantly increased and persisted into late COVID (p < .01). COVID-19 related operating room closures led to an expected decrease in the number of operative cases. However, there was no significant decline in the number of burn specific cases. The elective cases were largely replaced with excision and grafting cases and this shift has persisted even after elective cases have resumed. This change is also reflected in increased operative times.

What is the impact of the COVID-19 pandemic on residency training: a systematic review and analysis

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has greatly affected medical education in addition to clinical systems. Residency training has probably been the most affected aspect of medical education during the pandemic, and research on this topic is crucial for educators and clinical teachers. The aim of this study was to understand the effect of the COVID-19 pandemic comprehensively through a systematic review and analysis of related published articles.

METHODS

A systematic review was conducted based on a predesigned protocol. We searched MEDLINE and EMBASE databases until November 30, 2020, for eligible articles. Two independent reviewers extracted data by using a customized form to record crucial information, and any conflicts between the two reviewers were resolved through discussion with another independent reviewer. The aggregated data were summarized and analyzed.

RESULTS

In total, 53 original articles that investigated the effect of the COVID-19 pandemic on residency training were included. Studies from various regions were included in the research, with the largest percentage from the United States (n = 25, 47.2%). Most of these original articles were questionnaire-based studies (n = 44, 83%), and the research target groups included residents (79.55%), program directors (13.64%), or both (6.82%). The majority of the articles (n = 37, 84.0%) were published in countries severely affected by the pandemic. Surgery (n = 36, 67.92%) was the most commonly studied field.

CONCLUSIONS

The COVID-19 pandemic has greatly affected residency training globally, particularly surgical and interventional medical fields. Decreased clinical experience, reduced case volume, and disrupted education activities are major concerns. Further studies should be conducted with a focus on the learning outcomes of residency training during the pandemic and the effectiveness of assisted teaching methods.

Breast reconstruction during the COVID-19 pandemic: A systematic review

BACKGROUND

The novel coronavirus disease 2019 (COVID-19) has changed people's way of life and posed great challenges to plastic surgery. Most of plastic surgeries are considered elective surgeries and are recommended to be delayed. But breast reconstruction in plastic surgery is special. Doctors' associations from different countries have different rules on whether breast reconstruction surgery should be delayed. For the controversial topic of immediate breast reconstruction in the COVID-19 pandemic, we conducted this study.

METHODS

We searched English databases such as PubMed, Cochrane Library, and Embase. The publication time of papers was set to be from the establishment of the databases to February 2021. All studies on immediate breast reconstruction in the COVID-19 pandemic were included in our study.

RESULTS

A total of 6 studies were included in this study. Four studies recommended the use of breast implants or tissue expansion for breast reconstruction surgery and had good results in their clinical practice. In addition, 1 study planned to use autologous free tissue transfer for breast reconstruction, and 1 study planned to use microsurgical techniques for breast reconstruction. But these 2 technologies are still in the planning stage and have not yet been implemented.

CONCLUSIONS

In our opinion, breast cancer surgery belongs to confine operation, and breast reconstruction surgery should be performed immediately after the completion of breast cancer surgery. We recommend the use of breast implants for breast reconstruction surgery during the COVID-19 epidemic. Due to the limitations of the study, our proposed protocol for breast reconstruction surgery during the COVID-19 epidemic needs to be further validated in clinical studies.