Covid - 19 Protocols

Plastic surgeons as a group have from the very beginning of the coronavirus outbreak taken the care and protection of their patients and staff very seriously.  The American Society of Plastic Surgeons (ASPS) and The Aesthetic Society (ASAPS) provided early support and guidance to their members in this respect.  The question remained if these protocols (PPE, testing, etc.) made a difference.  A recent article (Teitlebaum, S, Diaz, J and Singer, R) published as an open access publication by The Aesthetic Society provides some positive answers to these questions.  112 board-certified plastic surgeons were surveyed as to:

  • their office protocols for SARS-CoV-2 testing pre- and post-operatively,
  • coronavirus related complications that they had seen in patients undergoing
    1. surgery (5633 cases),
    2. treatment with various energy devices (2519 procedures), and
    3. those receiving injectables (8506 patients).

41 of the pre-operative patients has a positive COVID test (0.69%). The community rate in Los Angeles County during that period was reported as high as 9 percent.  Two weeks following their treatment or surgery the patients were tested again.  The rate of positive test results was:

1-the surgical patients 0.13%,

2-patients receiving injectables 0.04%, and

3-the patients treated with a device had positive test rates of 0.24%.

No patient from the 3 groups required hospitalization and there were no deaths.

Although this study does give us some interesting data, it also has its limitations.  To start, it was based on a retrospective review.  Thus, it is dependent upon a review of charts and collating the data on the patients after they were treated.  Ideally, one would prefer a study of this sort to be prospective; that is, collecting the data starting before treatment and following the patients moving forward.

In addition, only, a fraction of practices queried (25%) responded.   This could skew the study in one direction or the other. This would happen if all the practices did not follow the same policies and there an inherent bias in the self-selection of the practices that responded to the survey. For example, were the practices that followed stricter protocols also more likely to respond? In addition, how was the testing done and which tests were used?

Setting aside the uncertainty raised by these and other issues, the study does, I believe, satisfactorily answer an important and critical question.  Patients who are seeking plastic surgery procedures including surgical, injectable, and energy device may do so safely.  They are not subjecting themselves to an increased risk of infection from the coronavirus.