Chen Jonlin, Chow Amanda, Lee Erica, Wesson Tristan, Karius Alexander, Wallam Sara, Generoso Matthew, Fadavi Darya, He Waverley, Yesantharao Pooja, Long Chao, Cooney Carisa M, Broderick Kristen P
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Reconstr Microsurg. 2023 Jan;39(1):59-69. doi: 10.1055/s-0042-1749677. Epub 2022 Jul 7.
Prevention of nosocomial coronavirus disease 2019 (COVID-19) infection for patients undergoing flap-based reconstructive surgery is crucial to providing care and maintaining operative volume and income to support plastic surgery programs. We conducted this study to (1) determine the postoperative incidence of COVID-19 among patients undergoing flap reconstruction from December 1, 2019 to November 1, 2020 and (2) compare 30-day outcomes between patients who underwent surgery before and during the early pandemic.
We conducted an 11-month retrospective cohort study of all patients who underwent flap reconstruction across our institution. We abstracted patient demographics, intraoperative management, COVID-19 testing history, and 30-day postoperative complications from electronic health records. Nosocomial COVID-19 infection was defined as reverse transcription polymerase chain reaction (RT-PCR) viral ribonucleic acid detection within 30 days of patients' postoperative course or during initial surgical admission. We used chi-squared tests to compare postoperative outcomes between patients who underwent surgery before (prior to March 12, 2021, when our institution admitted its first COVID-19 patient) versus during (on/after March 12, 2021) the pandemic.
Among the 220 patients (mean [standard deviation] age = 53.8 [18.1] years; female = 54.8%) who underwent flap reconstruction, none had nosocomial COVID-19 infection. Five (2%) patients eventually tested COVID-19 positive (median time from surgery to diagnosis: 9 months, range: 1.5-11 months) with one developing partial flap loss while infected. Between patients who underwent free flap surgery before and during the pandemic, there were no significant differences in 30-day takebacks (15.6% vs. 16.6%, respectively; > 0.999), readmissions (9.4% vs. 12.6%, respectively; = 0.53), and surgical complications (e.g., total flap loss 1.6% vs. 2.1%, = 0.81).
Robust precautions can ensure the safety of patients undergoing flap surgeries across an academic medical institution, even during periods of high COVID-19 admission rates. Further studies are needed to generate evidence-based guidelines that optimize infection control and flap survival for patients undergoing reconstruction.
对于接受皮瓣重建手术的患者，预防医院获得性2019冠状病毒病（COVID-19）感染对于提供医疗服务以及维持手术量和收入以支持整形手术项目至关重要。我们开展这项研究旨在：（1）确定2019年12月1日至2020年11月1日期间接受皮瓣重建手术患者术后COVID-19的发病率；（2）比较在疫情早期之前和期间接受手术的患者的30天预后情况。
我们对本机构所有接受皮瓣重建手术的患者进行了一项为期11个月的回顾性队列研究。我们从电子健康记录中提取了患者人口统计学信息、术中管理情况、COVID-19检测史以及术后30天并发症情况。医院获得性COVID-19感染定义为患者术后病程30天内或初次手术入院期间逆转录聚合酶链反应（RT-PCR）检测到病毒核糖核酸。我们使用卡方检验比较在疫情之前（2021年3月12日之前，即我们机构收治首例COVID-19患者之前）与期间（2021年3月12日及之后）接受手术的患者的术后预后情况。
在220例接受皮瓣重建手术的患者中（平均[标准差]年龄 = 53.8 [18.1]岁；女性占54.8%），无医院获得性COVID-19感染病例。5例（2%）患者最终COVID-19检测呈阳性（从手术到确诊的中位时间：9个月，范围：1.5 - 11个月），其中1例在感染期间出现部分皮瓣坏死。在疫情之前和期间接受游离皮瓣手术的患者之间，30天内再次手术率（分别为15.6%和16.6%；P > 0.999）、再入院率（分别为9.4%和12.6%；P = 0.53）以及手术并发症（如皮瓣完全坏死，分别为1.6%和2.1%；P = 0.81）均无显著差异。
即使在COVID-19入院率较高的时期，强有力的预防措施也能确保学术医疗机构中接受皮瓣手术患者的安全。需要进一步开展研究以制定基于证据的指南，优化接受重建手术患者的感染控制和皮瓣存活情况。
