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LETTER TO THE EDITOR • Braz. j. otorhinolaryngol. 89 (6) • 2023 • https://doi.org/10.1016/j.bjorl.2023.101329   copy

Unveiling evolving surgical landscape amidst the pandemic: a comprehensive analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Dear Editor,

The global healthcare landscape underwent significant transformations in response to the COVID-19 pandemic, marked by resource constraints and the deferment of elective surgeries to alleviate strain on healthcare systems. The field of Oral and Maxillofacial Surgery also experienced these shifts, prompting the need to comprehend patient profiles to inform preventive measures and planning strategies. A retrospective examination, approved by the research ethics committee under Protocol no 5,875,699, delved into medical records of patients undergoing facial trauma surgeries at a prominent Minas Gerais hospital between January 2018 and December 2021. The study scrutinized surgical procedures and their underlying determinants across two distinct epochs: the pre-pandemic and pandemic eras.

Interestingly, the pandemic triggered a slight reduction in the average age of patients undergoing facial trauma surgeries. Male patients remained dominant in both periods, albeit with a minor decline during the pandemic. Surprisingly, the pandemic prompted an increased reliance on the public healthcare system (Unified Health System), juxtaposed with a notable decline in health plan coverage (-23.1%) (Table 1).

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Table 1
Characteristics of the patients included in the study.

Etiological factors were systematically categorized into fourteen groups. Notable reductions emerged in incidents involving animal-related accidents (-25.0%), falls from heights (-17.6%), firearm injuries (-53.8%), physical assaults (-24.6%), vehicular collisions (-50.0%), and sports-related accidents (-62.5%) during the pandemic. In contrast, traffic-related accidents, such as car (+24.0%), cycling (+25.7%), and motorcycle accidents (+18.3%), escalated. Likewise, falls from one’s height surged (+29.4%) (Table 2).

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Table 2
Difference between the types of accidents in the pre- and during the COVID-19 pandemic.

Fracture type distribution remained largely consistent, except for a significant rise in naso-orbito-ethmoidal complex fractures (+90.0%; p-value = 0.006). Facial polytrauma (+27.7%), foreign body removal (+100.0%), multiple mandibular fractures (+9.8%), and simple mandibular fractures (+5.0%) experienced an upward trajectory. Conversely, certain injuries like blunt stump injury (-66.7%), comminuted mandibular fractures (-100.0%), frontal bone fractures (-50.0%), Le Fort II maxillary fractures (-66.7%), nasal fractures (-24.4%), and orbital floor fractures (-66.7%) exhibited moderate declines (Table 3). Furthermore, an increase in the use of plates and screws for fixation was evident, while surgeries not requiring orthotic and prosthetic materials declined notably (-14.9%) (Table 4). These findings illuminate the fluid shifts in surgical procedures and their driving factors during the pandemic.

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Table 3
Difference between the types of fracture in the pre- and during the COVID-19 pandemic.
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Table 4
Difference between the need to use board Orthosis, Prothesis and Special Materials in the pre- and during the COVID-19 pandemic.

Comparison with study of Pagotto et al.11 Pagotto LEC, Santos TS, Pastore GP. Impact of COVID-19 on maxillofacial surgery pratice: a systematic review. Braz J Otorhinolaryngol. 2022;88:990-8. highlighted that emergency trauma services were relatively less affected by the pandemic, although elective procedures’ suspension and pandemic-induced psychological effects on surgeons were prevalent across specialties. This underscores the necessity for comprehensive strategies to address both immediate and long-term impacts of the pandemic on surgical training and patient care.

Despite limitations like its retrospective nature and focus on a single hospital, our study contributes significant insights into the intricate interplay between the COVID-19 pandemic, patient demographics, causal factors, and surgical practices within Oral and Maxillofacial Surgery. Amidst the ongoing pandemic and future healthcare challenges, a deeper understanding of these dynamics remains pivotal for informed adaptations, ensuring the continuity of high-quality patient care.

  • Funding
    There was no source of funding for the research.

Reference

  • 1
    Pagotto LEC, Santos TS, Pastore GP. Impact of COVID-19 on maxillofacial surgery pratice: a systematic review. Braz J Otorhinolaryngol. 2022;88:990-8.

Publication Dates

  • Publication in this collection
    04 Dec 2023
  • Date of issue
    2023

History

  • Received
    17 Aug 2023
Creative Common - by 4.0
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
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