Trends in Plastic Surgery and Craniofacial Case Volumes Before and During the COVID-19 Pandemic: An ACS-NSQIP...

The COVID-19 pandemic created a significant strain on patients' abilities to receive both overall plastic surgery and craniofacial care by impacting the overall case volume. The aim of this study was to describe the plastic surgery and craniofacial case volume trends and characteristics during the COVID-19 pandemic in 2020. This was a retrospective study using the ACS National Surgical Quality and Improvement Program (NSQIP) database to analyze all patients undergoing plastic surgery procedures from January 2016 to December 2020. A subset of craniofacial procedures was used for subgroup analysis. Procedure trends throughout the year along with demographic and patient-specific variables were noted. A dynamic seasonal autoregressive integrated moving average (SARIMA) time-series model was fit using 2016 to 2019 data to forecast procedure frequency in a projected 2020 and then compared with the observed procedure frequency in 2020. A total of 149,978 plastic surgery procedures-including 3384 craniofacial procedures-revealed trends showing decreasing case volumes in 2020. In Q2 2020, elective procedures fell (39.3% overall, 15.1% for craniofacial) while emergent/urgent procedures increased (17.3% overall, 27.3% for craniofacial). Demographic trends in 2020 showed a decrease in the proportion of white patients and outpatient cases. The SARIMA model predicted an increase in 2020 case volume but observed frequencies showed a significant decrease in elective procedures. This study demonstrates the impact a pandemic can have on the ability to provide craniofacial and overall plastic surgery care. The results may better inform how to anticipate case volume trends and adapt practices to major health care disruptions in the future.