The effect of the ongoing COVID-19 nationwide lockdown on plastic surgery trauma caseload?

Dear Sir,

‘This is a Saint Patrick's Day like no other’ declared the Irish Prime Minster on March 17th 2020, whilst announcing sweeping social restrictions in a response to the worsening COVID-19 pandemic. This nationwide lockdown involved major restrictions on work, travel and public gatherings and signified the government's shift from the suppression to the mitigation phase of the outbreak. The national COVID-19 Task Force produced a policy specifying the redeployment of heath care workers to essential services such as the emergency department and intensive care. With the introduction of virtual outpatient clinics and the curtailment of elective operating lists, the apparent clinical commitments of a plastic surgeon during this pandemic has lessened. Trauma is a continual and major component of our practice; however, a decline in emergency department presentations has fuelled anecdotal reports of a reduction in the trauma workload. With diminishing resources, the risk of staff redeployment and consequences of poor patient outcomes we aim to assess the effect of the current lockdown due to COVID-19 pandemic on plastic trauma caseload.

We performed a retrospective review of a prospectively maintained trauma database at a tertiary referral hospital. Patients undergoing plastic trauma surgery during the first 25 days of nation wide lockdown (18th March to April 12th 2020) were evaluated. Referral numbers and surgeries performed were analysed and compared to the same time frame (18th March to April 12th) for the previous two years, 2019 and 2018.

During the first 25 days of the lockdown, 48 patients attended plastic surgery trauma clinic, in which 41 (85.4%) underwent a surgical procedure. As seen in Figure 1 , these numbers are comparable over the same time frame for the two previous years. Upper limb trauma accounted for the near majority of referrals. Frequency and type of surgery performed during the lockdown were similar to the previous two years, as seen in Table 1 . The percentage of patients requiring general anaesthesia was 46.3% (19/41) in 2020, 44.2% (19/43) in 2019, and slightly higher in 2018 at 58.9% (23/39).

Figure 1

Volume of plastic trauma referrals and surgeries in the current lockdown (2020) compared to same time in previous years (2019, 2018).

Table 1

Surgeries performed during the current lockdown (2020) compared to same time in previous years (2019, 2018).

	2018	2019	2020
Wound exploration
Primary closure	9	13	9
FTSG/local flap/SSG	4	3	3
Washout abscess	0	0	4
Repair nailbed	2	6	3
Removal FB	3	0	1
Tendon repair
Flexor	4	6	4
Extensor	3	6	3
Nerve Repair	6	4	4
Artery anastomosis	2	0	0
Fracture Fixation	6	3	2
Termilisation	5	4	7
Nerve Repair	6	4	4
MUA/ K Wire removal	1	0	2
Collateral ligament	1	0	1
Total	52	49	47

We have refuted any anecdotal evidence proposing a decline in plastic trauma caseload during the COVID19 nationwide lockdown. Comparing the same time in previous years, the lockdown has produced an equivalent trauma volume. Despite, the widespread and necessary restriction of routine elective work, somewhat surprisingly the pattern and volume of trauma remains similar to preceding years. With people confined to their household, it is the ‘DIY at home’ associated injuries which attributes to this trend. And the exemption from regulations of certain industries such as agriculture and the food preparation chain. Whilst not every trauma risk may be mitigated, the potential for these DIY injuries to overwhelm the healthcare service has resulted in the British Society for Surgery of the Hand (BSSH) cautioning the general public on the safety of domestic machinery.

As healthcare systems are stretched further than ever before we all must recognise the need for adaptation and structural reorganisation to treat those of our patients most in need during this pandemic. Staff redeployment is a necessary tool to maintain frontline services; nonetheless, we wish to highlight the outcomes of this study to the clinical directors with the challenging job of allocating resources. Our trauma presentations have not reduced during the first 25 days of this pandemic, resources (staff and theatre) should still be accessible for the plastic surgery trauma team, with observance of all the appropriate risk reduction strategies as documented by British Association of Plastic, Reconstructive and Aesthetic Surgeons.

Declaration of Competing Interest

None.