A Summary of Recommendations for Plastic Surgeons During the Coronavirus Disease 2019 Outbreak

Anna R. Schoenbrunner, MD; Benjamin A. Sarac, BS; Jeffrey E. Janis, MD


Plast Reconstr Surg Glob Open. 2020;8(7):e3039 

In This Article


Plastic surgery represents a broad field of practice, encompassing a range of acuities and patient ages. As such, recommendations on elective plastic surgery must be nuanced to encompass the diverse nature of the specialty. National and state guidelines provide a framework for plastic surgeons to reorganize their practices based on exposure risk and resource limitations. The enforceability of current CMS and state-level guidelines remains unclear. Readers are directed to their respective state's resources for further information.

National society guidelines, particularly ASPS, ACS, and Society of Surgical Oncology, provide more nuanced guidance for certain procedures.[1,48,52] Plastic surgeons must critically examine their practices to determine the level of acuity of their patients and interventions. When questions arise regarding the appropriateness of a surgical intervention, surgeons may turn to institutional bioethicists for guidance or refer to published ethical considerations during the COVID-19 outbreak.[68] Those procedures that qualify as elective should be postponed in an effort to minimize exposure risk and aid in the collective effort to preserve limited PPE supply (Figure 1).

Figure 1.

A visual framework for plastic surgeons to assess the elective nature of an intervention. Plastic surgeons should assess national, state, and societal guidelines, where they exist, for specific guidance on definitions of elective procedures. They should then assess resource limitations of their healthcare system to determine the staffing and PPE availability that may be needed for their intervention. Plastic surgeons should use their clinical judgment to determine the acuity of their patient's condition and timeliness of an intervention. Exposure risk, health system capacity, and acuity of the patient's condition must be considered. These factors must be weighed against the severity of the COVID-19 outbreak within a community to determine the appropriateness of a surgical intervention. Such decisions are ultimately guided by ethical considerations.

As states begin to resume elective surgeries, plastic surgeons must remain apprised of guidelines issued by states and societies, as local COVID-19 outbreaks will impact transmission risk, hospital capacity, and PPE supply. Local surges also may reimpose restrictions on elective procedures.[5,46] Of special note, ASPS recommends that members obtain additional informed consent due to risk of SARS-CoV-2 infection by proceeding with elective surgery (see Appendix, Supplemental Digital Content 2, which shows the statement of informed consent, http://links.lww.com/PRSGO/B456).[46] Plastic surgeons must partner with local and state public health departments, hospital and clinic administrations, and patients to ensure a safe resumption of elective surgeries.