Evaluating Postoperative Outcomes of Patients Undergoing Elective Procedures in an Ambulatory Surgery Center During the COVID-19 Pandemic.

BACKGROUND: Despite the rapid increase in the number of publications pertaining to COVID-19, there is a lack of data examining patient outcomes following elective procedures performed during this pandemic. OBJECTIVES: The purpose of this investigation was to examine the postoperative outcomes of patients who underwent elective procedures in an ambulatory surgery center during the COVID-19 pandemic, and to share the preoperative screening and patient selection protocol implemented in our center. METHODS: Elective procedures performed in an ambulatory surgery center between March 1, 2020 and April 16, 2020 were retrospectively reviewed. The primary outcomes were occurrence of COVID-19-related postoperative complications. These complications include pneumonia, stroke, myocardial infarction, and clotting disorders. The predictive variables analyzed in this study were age, American Society of Anesthesiologists score, specialty conducting the procedure, operating time, and the type of plastic and reconstructive surgery procedure being performed. RESULTS: A total of 300 consecutive electives cases were included in the study. The most common procedures were pain management (43.0%), gastrointestinal (26.0%), aesthetic (14.0%), orthopedic (10.3%), reconstructive (4.0%), otorhinolaryngology (2.0%), and gynecology (0.67%). The median age of the cohort was 54.6 years (range, 1-90 years) and the median procedure time was 47 minutes (range, 11-304 minutes). COVID-19-related symptoms or complications following the procedures were not observed in any of the patients or in the healthcare care personnel. CONCLUSIONS: In this cohort of 300 elective cases, we found no patients with COVID-19-related symptoms postoperatively. This suggests that with proper preoperative screening and patient selection, elective procedures can be safely performed in an ambulatory surgery center during this pandemic.

Comparison of breast augmentation incisions and common complications.

UNLABELLED: The recent article by Stutman et al, regarding the comparison of breast augmentation incisions and complications was reviewed with emphasis on capsular contracture. In contrast to other articles in the literature, the authors did not find a difference in contracture rates between the inframammary, periareolar, and transaxillary incisions. The patient data used, however, did not include a key issue regarding contracture-the use of breast pocket irrigation, which has been shown to significantly reduce the incidence of contracture. The authors' conclusion that surgeons may proceed without worry that there is a difference in complication rates between incisions is contrary to mounting evidence. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Space obstructive syndrome: intracranial hypertension, intraocular pressure, and papilledema in space.

Humans undergo several consistent and measurable changes of fluid distribution and regulation in the course of adapting to microgravity. Recently, a syndrome of objective findings has been described by Mader et al. associated with long-duration missions, including hyperopic shifts, mildly elevated intracranial pressure, papilledema, globe flattening, choroidal folds, and other anatomic findings. Experience with venous obstructive lesions leads the author to propose a primary obstructive process, unique to or exacerbated by microgravity, acting at the level of the proximal internal jugular veins, termed Space Obstructive Syndrome (SOS). Literature, anatomy, and ultrasound observations revealed four major potential compression zones of the internal jugular vein, with Zone I between the sternocleidomastoid muscle and the carotid artery as the primary area of compression, both in 1 G in an upright position and in microgravity. Internal jugular vein compression, along with loss of gravitationally induced cranial outflow of blood in the vertebral veins and collaterals, may lead to intracranial venous hypertension with resultant facial/head and upper airway swelling, increased intraocular pressure, intracranial hypertension, and papilledema. Further study and proof of concept will necessitate ultrasound, Doppler flow study, and internal jugular vein pressure measurements on orbit in the International Space Station. If proven, SOS will give researchers opportunity for study and development of mitigation strategies such as artificial gravity systems.

A modified incision closure for breast augmentation: remote-knot technique.

Closure techniques for breast augmentation incisions can affect wound healing with significant consequences if the incision does not heal properly. Suturing methods and materials include absorbable and nonabsorbable sutures and interrupted and continuous techniques. These choices can affect wound healing, wound strength, and wound integrity, and postoperative care. The goal of long-term incision support during wound healing, eliminating a suture knot within the incision, and decreased risk of compromise of wound healing are desired. A closure method called the "remote-knot" technique, which can be applied to other incision types, has been developed.

Relationship of incision choice to capsular contracture.

BACKGROUND: Capsular contracture can be an ongoing problem in breast augmentation even with good surgical technique. In the author's practice, a higher incidence of capsular contracture was observed with the use of a periareolar incision than with an inframammary incision. METHODS: A review of breast augmentations performed from November 2004 through June 2006 was conducted. This analysis included the incision used, the procedure performed, and the development of capsular contracture. RESULTS: The incidence of contracture was 0.59% in the inframammary group and 9.5% in the periareolar group. This increase in capsular contracture with a periareolar incision was statistically significant. Capsular contracture occurring with augmentation performed at the time of a periareolar mastopexy was 8%, which was statistically significant compared with the inframammary group. The difference in contracture rates between a periareolar incision alone and a periareolar mastopexy was not statistically significant. CONCLUSIONS: Breast augmentation through a periareolar incision has a higher incidence of capsular contracture than observed with an inframammary incision. This most likely occurs due to an increase in contamination of the breast pocket with intraductal material colonized by bacteria. The periareolar incision is, and will remain, a standard of care. Therefore, this information can help clinicians make a more informed decision regarding incision placement for breast augmentation.

The role of betadine irrigation in breast augmentation.

BACKGROUND: In the spring of 2000, the U.S. Food and Drug Administration issued a ban on the use of Betadine (povidone-iodine; Purdue Frederick, Stamford, Conn.) in association with saline breast implants, because data seemed to indicate a higher rate of implant deflation in association with Betadine. Betadine has been used for many years because studies have shown a decrease in the rate of capsular contracture when the breast pocket is irrigated with Betadine at the time of augmentation. METHODS: Breast augmentations performed from January of 1998 through September of 2005 were reviewed. The review included an analysis of how Betadine was used at the time of each augmentation, along with the incidences of implant deflation and capsular contracture. Findings were compared with data used by the Food and Drug Administration in their breast implant literature. RESULTS: The deflation rate was significantly lower than that reported in the data from the Food and Drug Administration and the Institute of Medicine (0.24 percent versus 7 to 10 percent). The capsular contracture rate was lower than that in the Food and Drug Administration data, especially when Betadine was used as indicated in the final phase (0.5 to 2.2 percent versus 10 to 11 percent). CONCLUSIONS: This article confirms other studies reporting that the use of Betadine has no effect on the rate of deflation of a saline breast implant. It also shows that the incidence of capsular contracture is significantly decreased with the proper use of Betadine.