Ambulatory day case oncoplastic and reconstructive breast surgery during the peak of COVID 19 pandemic

Abstract

Background: The World Health Organization (WHO) declared a novel coronavirus disease 2019 (COVID 19) pandemic on the 11 March 20 In response to this, the United Kingdom (UK) Association of Breast Surgeons (ABS) released guidelines on breast cancer management during the pandemic on the 15 March 20 The UK was in lockdown on the 23 March 20 Whilst the UK breast units adapted to deliver safe cancer services, many limited and some stopped all oncoplastic and reconstructive breast surgery (OPRBS) With careful stratification and prioritisation of cases, coupled with our existing successful integrated ambulatory day case surgery pathway, our unit continued to perform OPRBS safely and we present the outcomes of our OPRBS during the pandemic Materials and Methods: OPRBS performed between 11 March 20 and 31 July 20 were included in this study All OPRBS cases were supported by our multidisciplinary team Surgeons and patients followed hospital’s COVID 19 precautions policy Primary outcome measured was COVID 19 exposure before or after surgery Secondary outcomes measured were 30 days surgical complications and delay in adjuvant treatment Results: A total of 117 patients (120 breasts) had breast cancer related surgeries during the study period Ten patients (12 breasts), that is 10% underwent immediate OPRBS following breast conserving surgery or mastectomy were included in the study analysis All OPRBS were planned for ambulatory day case surgery (ADCS) Patients age ranged was from 35 to 63 years There were 6 pre-pectoral implant based reconstructions, 4 partial breast reconstruction with chest wall perforator flaps, 1 therapeutic mammoplasty, and 1 central BCS with nipple reconstruction None contracted COVID 19 before or after surgery, 2 patient developed minor complications with no delay in adjuvant treatment Six patients were discharged on the day of surgery, and 4 patients were discharged within 23 hours of admission as part of our unit s integrated ADCS (<23 hours stay) pathway Conclusions: With an established integrated ambulatory day case surgery pathway, and careful stratification and adherence to COVID 19 precautions, oncoplastic and reconstructive breast surgery can be delivered safely and effectively during the peak of the pandemic Our model can be extrapolated to the reshaping and resuming of oncoplastic and reconstructive breast surgery in the era of COVID 19