High-Efficiency Same-Day Approach to Breast Reconstruction During the COVID-19 Crisis.
PURPOSE
As our hospitals conserve and re-allocate resources during the COVID-19 crisis, there is urgent need to determine how best to continue caring for breast cancer patients. During the time window before the COVID-19 critical peak and particularly thereafter, as hospitals are able to resume cancer operations, we anticipate that there will be great need to maximize efficiency to treat breast cancer. The goal of this study is to present a same-day protocol that minimizes resource utilization to enable hospitals to increase inpatient capacity, while providing care for breast cancer patients undergoing mastectomy and immediate breast reconstruction during the COVID-19 crisis.


METHODS
IRB exempt patient quality improvement initiative was conducted to detail the operationalization of a novel same-day breast reconstruction protocol. Consecutive patients having undergone immediate breast reconstruction were prospectively enrolled between February and March of 2020 at Massachusetts General Hospital during the COVID-19 crisis. Peri-operative results and postoperative complications were summarized.


RESULTS
Time interval from surgical closure to patient discharge was 5.02 ± 1.29 h. All patients were discharged home, with no re-admissions or emergency department visits. No postoperative complications were observed.


CONCLUSION
This report provides an instruction manual to operationalize a same-day breast reconstruction protocol, to meet demands of providing appropriate cancer treatment during times of unprecedented resource limitations. Pre-pectoral implant-based breast reconstruction can be the definitive procedure or be used as a bridge to autologous reconstruction. Importantly, we hope this work will be helpful to our patients and community as we emerge from the COVID-19 pandemic.
['Specht|Michelle|M|', 'Sobti|Nikhil|N|', 'Rosado|Nikki|N|', 'Tomczyk|Eleanor|E|', 'Abbate|Olivia|O|', 'Ellis|Dan|D|', 'Liao|Eric C|EC|http://orcid.org/0000-0001-6385-7448']
D000328:Adult D000359:Aftercare D000556:Ambulatory Surgical Procedures D000776:Anesthesiology D000073640:Betacoronavirus D019928:Breast Implantation D018427:Breast Implants D001943:Breast Neoplasms D000086382:COVID-19 D018270:Carcinoma, Ductal, Breast D002985:Clinical Protocols D018352:Coronavirus Infections D004526:Efficiency D004636:Emergency Service, Hospital D005260:Female D006295:Health Resources D006699:Home Care Services D006801:Humans D007902:Length of Stay D016462:Mammaplasty D008408:Mastectomy D008875:Middle Aged D058873:Pandemics D010359:Patient Readmission D019990:Perioperative Care D011024:Pneumonia, Viral D011446:Prospective Studies D058996:Quality Improvement D000086402:SARS-CoV-2 D021701:Sentinel Lymph Node Biopsy D013518:Surgery, Plastic D000071077:Surgical Oncology D017216:Telemedicine D015625:Tissue Expansion Devices
Same-day Breast reconstruction COVID-19 Protocol Coronavirus