SA2 - How has the COVID-19 Pandemic Impacted the Clinical Volume and Variety of an Academic Oral and Maxillofacial Surgery Program?

Purpose:
Attempts to mitigate the coronavirus disease of 2019 (COVID) have disrupted the delivery of non-pandemic care. The purpose of this study was to evaluate the effects of the COVID pandemic on surgical volume and variety at an academic oral and maxillofacial surgery program.
Materials and methods:
A retrospective cohort study was conducted using the surgical logs of the University of Pennsylvania, Department of Oral and Maxillofacial Surgery from January 2012 through January 2021. Each record identified patient demographics and case classifications. Of note, the surgical logs analyzed were only those which were performed in the operating room and not the outpatient clinic nor emergency department. The study predictor was timing of care, which was divided into pre-pandemic, peak pandemic, or post-peak pandemic. The primary study outcomes were the monthly procedure count and the procedure categories. The secondary dependent variables were patient age and race. Multivariate and univariate analyses of variance were used to determine whether pandemic effects existed within outcome groups.

Results:
The final sample included 64,709 surgical procedures (Table 1). Before, during, and after the pandemic peak, there were means of 691.0, 209.0, and 789.4 procedures per time period, respectively (p < 0.01) (Table 2). There were significantly more infection (baseline 2.2%, peak 6.0%, post-peak 2.0%, p<0.01) and trauma (baseline 5.3%, peak 26.7%, post-peak 3.9%, p<0.01) cases during the pandemic peak (Table 3). The mean percentage of pediatric patients increased during the peak and post-peak periods (baseline 2.4%, peak 12.9%, post-peak 10.2%, p<0.01) (Table 3). No differences were observed among the mean percentage of white (p=0.12), black (p=0.21), and Hispanic (p=0.25) patients treated (Table 3).

Conclusion:
Along with a predictable decline in surgical numbers, a greater proportion of infection and trauma procedures were performed at the pandemic’s peak; trauma accounted for over a quarter of surgical cases during this peak. One potential reason for this could be due to an increase in at-home domestic violence. Pennsylvania issued a stay-at-home order for Philadelphia County from March 23 until May 8, 2020. A recent study highlighted that there was a regional decrease in the overall volume of trauma at the University of Pennsylvania [1]. This was largely driven by parallel decreases in the number of unintentional injury mechanisms, such as motor vehicle collisions. Interestingly, there was a paradoxical increase in the number of intentional interpersonal injuries [1]. In fact, the number of domestic assault cases grew by at least 5% during this time at the national level [2].
The increase in infections may be due to outpatient dental services being inaccessible during the pandemic’s peak, causing patients with odontogenic infections to have limited care options. Furthermore, because most patients were avoiding local emergency departments that were overwhelmed with COVID, it is probable that certain mild infections that otherwise could be treated in-office may have transformed into more severe airway threatening conditions that required operating room drainage. Despite all these changes, surgery volume normalized, and case variety returned to pre-pandemic levels in the post-peak period. Our study suggests that the addition of COVID restrictions did not change the case volume or variety in the months after the initial crisis.

References:
1. Abdallah HO, Zhao C, Kaufman E, Hatchimonji J, Swendiman RA, Kaplan LJ, Seamon M, Schwab CW, Pascual JL: Increased Firearm Injury During the COVID-19 Pandemic: A Hidden Urban Burden. J Am Coll Surg 232:159, 2021
2. Hsu LC, Henke A: COVID-19, staying at home, and domestic violence. Rev Econ Househ 1, 2020.