Clinical audit
The number of outpatient visits, patients presented during weekly multidisciplinary treatment planning conferences and treatment recommendations were recorded for 6 weeks, from March 1 (first COVID-19 case in county) to April 9, 2020 (Table 2). The surgical caseload was recorded over a 3-week period, starting on March 23rd, 2020 (first COVID case in the institution). Similar numbers were derived from the same time period of 6 and 3 weeks respectively from 2019. Modifications of oncologic treatment strategies were recorded.
The total number of outpatient visits in the head and neck center dropped from 6836 to 3628 (-46.7%) from 2019 to 2020. The greatest decrease was in the follow-up visits (-51.1%), consistent with the postponement of routine follow-up visits in stable, treated patients. The number of cases presented at weekly multidisciplinary treatment planning conference decreased by 21.7%. Over the same period, recommendations for surgical treatment declined from 103 (34.4% of total) to 57 (24.4% of total), representing a 44.7% decrease. On the other hand, the percentage of cases recommended for neoadjuvant treatment prior to surgery slightly increased from 3.3% to 4.7%.
The number of head and neck surgeries performed over 3 weeks (starting March 23) decreased from 111 to 59 (-46.8%). This decline coincides with the initiation of the Division of Surgery (DoS) Surgical Posting Review Committee on March 25th to review all case postings, and a simultaneous development of specific guidelines within the department.12 Modifications of oncologic treatment are presented in Table 3. The majority of adjustments were postponement of surgeries, and there were alterations of the surgical procedure in three cases – in one case a free flap reconstruction was not performed, and in two other cases tracheostomies were successfully avoided.