Strategic surgical planning during COVID-19 pandemic: A retrospective analysis of maxillofacial surgical activity

Editor

Projections based on a Bayesian β-regression model estimated that 28·4 million operations would be cancelled or postponed during the 12 weeks of COVID-19 disruption for 190 countries¹. This international study, undertaken by CovidSurg Collaborative, recommended governments proactively react to the global health-care crisis by developing recovery plans and implementing strategies to restore surgical activity². At a local level we implemented our own strategic surgical plan, in order to minimise disruption in delivering a maxillofacial surgical service to our patients. This included retention of staff, but at the same time augmenting our surgical team with staff from less acute care specialities as part of the redeployment programme. We deemed this move necessary, based on the predicted increase in workload following our newly agreed role in delivering the surgical tracheostomy service for COVID-19 patients³. At the start of April 2020, all surgical trainee out-patient clinic activity was cancelled. This not only reduced the risk of cross-infection but also allowed a greater degree of workforce flexibility and movement of staff if the need arose. Our department needed to be able to react to any anticipated increase in workload demands, as at times our team needed to be split over two hospital sites, covering the needs of two Intensive Care Units. Furthermore, the junior rota was also reconfigured with minimal number of required staff being present at any one time during daily ward rounds. This became an important part of the strategic planning in limiting any potential spread of the coronavirus disease amongst staff, as some colleagues needed to self-isolate. During the peak of the coronavirus pandemic, all departmental admissions were sanctioned by the on-call Consultant. This was to avoid any unnecessary hospital admission and to limit spread of coronavirus amongst staff and patients. We also set up a ward-based operating room to perform procedures under local and regional anaesthesia for cases such as incision and drainage of cervicofacial odontogenic infections. This set up was a successful method of preventing hospital admissions. One further component of our strategic planning during this turbulent time was successful negotiation of theatre time for our level 1 and 2 priority cases⁴. Competing for theatre time with other specialties can cause a strain on working relationships. In our Trust we followed a cooperative strategy⁵ which involved the sharing of theatre time for the major head and neck oncological surgical cases on alternate weeks between competing specialties.

With the implementation of the above measures we then retrospectively analysed our Trust surgical database, focussing on the number of surgical procedures performed for multiple surgical specialties, over two consecutive 4 weekly time periods, 4^th to 30^th March 2020 (Period 1) and 1^st to 28^th April (Period 2). Period 2 represents the time frame, when all non-emergency surgical activity was stopped in our Trust. During period 2 our department performed 200 procedures compared to 107 procedures performed during period 1. This represented an increase in surgical activity by 86·9 per cent, only second in ranking to Obstetrics (87·0 per cent), with Cardiothoracic surgery (28·3 per cent) ranking third. Some of the acute surgical specialties experienced decreased activity during period 2 of the study, with Gynaecology (−66·3 per cent), Otorhinolaryngology (−48·8 per cent) and Urology (−40·7 per cent) being mostly affected during the COVID-19 disruption.

It is our opinion that the appropriately timed strategic surgical planning carried out during the COVID-19 pandemic, in addition with international society recommendations^1,2 enabled our department to increase our surgical activity relative to other surgical specialties.