Why is there so much confusion on whether elective cases (including breast reconstruction) can start to resume?
Yes, there’s lots of confusion, especially as it relates to a hospital setting versus other surgery centers. Obviously, a lot of a lot of plastic surgeons operate either out of their offices or they have operative suites. Many of them have surgery centers or ambulatory surgical centers. There has been a lot of mixed messaging and some confusion for sure.
For us [in San Antonio], we are operating again. I am very happy with the procedures in place at the local hospitals in terms of testing. I am one of those who believes that we need testing for all patients. Personally, I would not be comfortable offering [breast reconstruction] surgery to people right now without pre-operative COVID-19 testing. There are pros and cons to every approach but that’s just my take.
We must have consistent, good, safe practices and protocols for everyone. Specifically, the surgical community fears operating on asymptomatic positive patients (someone who is positive who doesn’t know it because they’re not showing any symptoms). There’s some data out there that suggests that positive patients who are asymptomatic are at higher risk of developing post-operative complications. You’ve got to take that data seriously.
There was a study out of China that looked at elective patients having surgery (various specialties not just breast reconstruction). They looked at patients who were actually, in retrospect, positive for COVID-19 but at the time hadn’t shown any symptoms so they would have passed all verbal screening measures. Many of those patients ended up getting complications after surgery that otherwise you wouldn’t have expected them to have. There was a very high rate of pneumonia and mortality. Mortality was actually 20%. There’s lots of other data you have to take into account too. What’s the risk of someone being an asymptomatic carrier, what’s the rate of infection in the community…?
In San Antonio, only 10% of people being tested for COVID-19 are coming back positive. But, without mass testing you don’t know what the baseline rate of infection is.
There is a school of thought that’s a lot less restrictive… If you have a low risk patient who hasn’t had any obvious exposure, who passes all the verbal screening and physical screening (no symptoms, normal temperature, normal oxygen saturation on a pulse oximetry)… you don’t need testing on that person. That’s a track that some surgeons are pursuing and there’s definitely some value and an argument to pursue that line, and to reserve testing for only the high-risk group.
I don’t want people to take away from this that if your surgeon doesn’t test you pre-operatively, then you shouldn’t be having the surgery…that’s not what I’m saying. You have to take into account your individual situation, the geographic location, what’s going on where you are, and just have a very honest conversation with your surgeon, and talk about the protocol [they’re using].