ABSTRACT
Background/Purpose: COVID-19 fundamentally changed cleft teams' ability to care for their patients. This study aims to study;1) the effect of COVID-19 on elective surgery timings and outcomes;2) preoperative screening and isolation protocols;3) the impact of operating with personal protective equipment (PPE). Methods/Description: Between the start of the first UK lockdown in March 2020 and April 2021 operative details from 651 cleft procedures performed in eight UK centres were entered into a secure REDCap database. Results: 651 records were entered (59% male, 41% female). 9% patients had a known syndrome. Operations were as follows: cleft palate repair (40%), unilateral cleft lip repair +/- vomer flap (23%), alveolar bone grafting (16%), secondary speech surgery (10%), fistula repair (3.7%), lip revision (1%) and rhinoplasty (1%). 39% of surgical cases were deemed delayed compared to normal protocol timings, with 80% of the delays attributable to COVID. Mean age at initial cleft lip repair was 230 days exceeding a previous representative mean of 137 days as well as breaching the UK national standards for upper age limit of 183 days. Mean age at cleft palate repair was 387 days compared to the UK national standard for upper age limit of 396 days, and previous representative mean of 320 days. 81% of patients undertook some form of pre-operative isolation;47% isolated for two weeks. COVID screening was performed in the 72 hrs prior to surgery in 89% of patients and 13% of parents/carers. Only one patient had a positive test. 69% surgeons wore an FFP3 (N99) mask to operate, and 64% of cases involved difficulty during the operation as a result of the PPE;most commonly communication difficulties (45%). No patients developed COVID in the early post-operative period. Conclusions: This data demonstrates that initial cleft lip and palate repair in the UK has been delayed as a direct result of the COVID-19 pandemic. Secondary surgery has been significantly affected and efforts will need to be made at national level to provide capacity to catch up. Isolation and testing protocols for COVID-19 vary from unit to unit, but appear safe. Routine cleft surgery can safely continuing through the pandemic, as long as appropriate infection control measures are followed and resources allow.
ABSTRACT
Background/Purpose: Since the outbreak of COVID-19 was declared a pandemic, there has been concern regarding the social isolation born from safety mandates. Literature suggests that social distancing guidelines provoke anxiety and uncertainty among children and adolescents. This study aims to evaluate the effects of pandemic guidelines on pediatric patients with craniofacial conditions (CFCs), by studying the Health-Related Quality of Life (HRQoL) in a matched sample of pediatric patients with CFCs prior to and during the COVID-19 pandemic. Methods/Description: This matched cohort study (N=88) utilized the Craniofacial Quality of Life Scale (CFC-QoL), a bilingual patient- and parent-reported outcome measure, to assess social and psychological HRQoL domains. CFC-QoL surveys were collected from CFC patients and parents prior to March 11, 2020 (pre-pandemic) and compared to a separate cohort that completed the survey after July 1, 2020, during the pandemic. The patients in each sample (n = 44) were matched by diagnosis (bilateral or unilateral cleft lip and palate, craniosynostosis, microtia or dermatologic condition), age range (7-12, 13-17, 18+) and gender. Mean scores for both patient and parent responses to each survey item within the social and psychological impact subscales were computed and compared between the matched cohorts. Results: Comparison of mean responses found significant differences between the pre-pandemic and pandemic cohorts. On the social impact subscale, patients in the pandemic sample reported that 'People tease me', 'People ask me what is wrong with my face', and 'People notice that my face is different' less often than those in the pre-pandemic sample (p = .021;p = .041;p = .038). Parents in the pandemic sample reported 'People ask my child what is wrong with their face' and 'People notice my child's face is different' less often compared to the pre-pandemic sample (p = .040;p = .020). Within the psychological subscale, patients in the pandemic sample reported feeling less worried about their future (p = .030), less anxious or scared (p = .024), and more likely to try new things (p = .039) compared to those who answered the survey pre-pandemic. The parents in the pandemic sample reported 'My child feels bad about himself/herself' less often compared to parents in the prepandemic sample (p = .038). Conclusions: This study found that a sample of patients with CFCs and their parents reported better indications of social and psychological HRQoL during the COVID-19 pandemic compared to a matched pre-pandemic cohort. Factors that might influence these findings include decreased negative social impact due to containment measures such as school closures. Additionally, enforced mask wearing in social settings may serve as a protective barrier to decrease negative attention drawn toward a child's facial differences.