The Impact of COVID-19 on Free Tissue Transfer Outcomes: A NSQIP Analysis

BACKGROUND: The COVID-19 pandemic significantly impacted hospital resources and patient care, though its effect on free tissue transfer procedures is less well understood. We conducted the current study to investigate the potential impact of COVID-19 and its accompanying system shut-downs on the surgical outcomes of patients undergoing free flap procedures. METHODS: Patients undergoing free tissue transfer procedures were identified from the National Surgical Quality Improvement Program (NSQIP) database from 2016 to 2020. We used 2016-2019 as baseline (pre-pandemic) data to compare with 2020 (peri-pandemic). We divided patients into three groups: all patients undergoing free tissue transfer, breast reconstruction free tissue transfer, and non-breast free tissue transfer cases. Outcomes of interest included patient morbidity/mortality, time-to-surgery, time-to-takeback, and length of hospital stay. We used Pearson’s chi-square and Fischer’s exact tests to assess categorical variables. Wilcoxon’s ranked sign tests and ANOVA Test were used for non-parametric and parametric continuous variables, respectively. Significance was set at alpha <0.05. RESULTS: When comparing peri-pandemic to pre-pandemic rates, patient morbidity and mortality and unplanned primary or secondary takeback operations were both significantly higher in all three groups peri-pandemic. Median time to primary or secondary takeback operation was also significantly greater peri-pandemic. CONCLUSION: Patients undergoing flap procedures peri-pandemic had an overall increase in median morbidity and mortality, unplanned primary or secondary takebacks, and median number of days to takebacks compared to the pre-pandemic period. This is concerning given that any future protocols instituted can have detrimental effects on patients who receive a free tissue transfer procedure.