The impact of COVID-19 on breast surgery during the height of the New York City pandemic

The COVID-19 pandemic has caused significant changes in cancer care delivery. This report describes the Breast Surgical Oncology Division’s experience at a quaternary care hospital within the geographic epicenter of the COVID-19 outbreak in the United States. This is a cohort study of patients scheduled for breast surgery at a single academic institution in New York City (NYC) between March 23–April 21, 2020. Patients who were scheduled for surgery were prospectively tracked in a surgical database. The primary outcome was the proportion of cases actually performed. Secondary outcomes were the clinical characteristics of the patients who received surgery and the perioperative methods used in this group. Of the 43 cases scheduled, 0% were emergent, 39.5% urgent, and 60.5% elective, and 15 (34.9%) actually had surgery during the study period. Thirty-two patients (74.4%) experienced a surgical delay. The mean delay of an urgent case was 3 days. Two of the patients had a change in surgical plan from bilateral mastectomy with reconstruction and sentinel lymph node biopsy (SLNB) to lumpectomy with SLNB. Only two patients were admitted postoperatively. Of the 17 patients who had localization, the planned localization method differed from the actual method in 7 (42%) patients. Of the 28 patients who did not have surgery during the study period, 8 (28.6%) initiated neoadjuvant endocrine therapy as a bridge to their eventual surgery. We conclude that the surgical management of patients with breast cancer has been significantly impacted at the height of the COVID-19 pandemic in NYC.