Lessons from the Epicenter of the COVID-19 Pandemic: An Analysis of the Surgical Completion Rates between Priority Classes and Procedure Types

In March of 2020, elective surgical procedures in New York State were suspended in response to the COVID-19 pandemic. At Northwell Health, this lasted a total of 8 weeks, leaving plastic surgeons responsible for recording and rescheduling delayed procedures. Many plastic and reconstructive procedures are considered elective, but these procedures can be time sensitive, and delays can have a negative impact on patient care.¹ Our goal was to compare the rates of completion and time to completion between different priority groups and procedure types in order to predict potential consequences for one’s practice if future suspensions in elective surgery were to occur. We hypothesized that procedures grouped in the reconstructive categories with higher priority levels would have a higher completion rate and lower time to completion compared to less urgent, aesthetic based procedures.

Plastic surgeons working for our department were responsible for keeping track of their suspended cases between March 23, 2020, and May 19, 2020.^2,3 Under the discretion of the attending plastic surgeon, cases were categorized into procedure type, priority level, and surgery setting. The procedure types included aesthetic, pediatrics/craniofacial, hand, general, and reconstructive. The priority classes were elective, nonurgent, semiurgent, urgent, and emergent. The surgery setting was classified into inpatient and outpatient.

In total, we examined 135 surgical cases that were suspended (Table 1). The average patient age was 45.8 years, and 45.9 percent of the surgical procedures were completed by the end of August of 2020, more than 3 months after the suspension was lifted. Of those that were completed, the average time to completion from the original surgical date was 79.2 days. Surgery classifications are summarized in Table 1. We ran binary logistic regressions that showed no significant correlation between the surgery type, urgency, or priority class and whether or not the surgery was completed. In addition, linear regression analyses did not show a significant correlation between the surgery type, urgency, or priority class and the time it took to complete the surgery. All the models controlled for patient age and whether or not there was malignancy.

Table 1.

Summary of Sample by Procedure Priority

Procedure Classification	No. of Patients	Percent of Sample
Priority
Elective	8	5.93%
Nonurgent	80	52.29%
Semiurgent	22	16.30%
Urgent	24	17.78%
Emergent	1	0.01%
Type
Aesthetic	12	8.89%
Pediatrics/craniofacial	10	7.41%
Hand	9	6.67%
General	35	25.93%
Reconstructive	68	50.37%
No type specified	1	0.74%
Location
Inpatient	34	25.19%
Outpatient	66	48.89%
No location specified	35	25.93%

Our surprising results may be due to several factors, including differences in patients’ concerns with undergoing surgery during a pandemic, patients’ continuous desire to undergo aesthetic surgery, or a lack of prioritization of urgent cases when rescheduling surgery. With new variants of SARS-CoV-2 emerging and the number of COVID-19 cases climbing rapidly in the United States,⁵ plastic surgeons must be prepared for another potential suspension of surgery.⁶ Plastic surgery departments and private practices can use our experience to guide their recovery from future surgical suspension. Prior studies have already shown the tremendous economic impact of surgery delays on plastic surgeons.⁴Additional research is needed, however, to evaluate the impact of delays on patient care and quality of life. A more systematic approach to rescheduling surgery, which prioritizes the most vulnerable patients, is needed.

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