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.