Socioeconomic impact of the COVID-19 pandemic among plastic surgeons in Brazil

RIBEIRO, RENAN DIEGO AMÉRICO; CARNEIRO, IGOR CASTRO; CLIVATTI, GUSTAVO MOREIRA; ABBAS, LAIELLY; MONTEIRO, GUSTAVO GOMES RIBEIRO; GOLDENBERG, DOV; GEMPERLI, ROLF

doi:10.5935/2177-1235.2022RBCP0025-en

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Revista Brasileira de Cirurgia Plástica

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Original Article • Rev. Bras. Cir. Plást. 37 (2) • Apr-Jun 2022 • https://doi.org/10.5935/2177-1235.2022RBCP0025-en copy

Socioeconomic impact of the COVID-19 pandemic among plastic surgeons in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

Global sanitary crisis caused by the spread of COVID-19 induced many health services to stop performing non-urgent surgical procedures. In the scenario of plastic surgery, where most procedures are elective, socioeconomic consequences are estimated for these specialists. The objective of this study is to measure this impact.

Methods:

Effects of the pandemic within the clinical practice of Brazilian plastic surgeons were investigated through an online questionnaire addressed to members of the Sociedade Brasileira de Cirurgia Plástica.

Results:

A survey was applied to 645 surgeons. Most respondents reported operation restrictions on procedures and income reduction, especially in regions severely affected by the pandemic. Plastic surgeons with more than 10 years of experience were the most affected. High contamination rates, mental overload, decreased physical activity, and psychiatric medications have also been reported.

Conclusion:

COVID-19 pandemic brought changes to the personal and professional life of the Brazilian plastic surgeon. Due to the significant reduction in the workload, there were financial impacts on specialists from all country regions, besides physical and mental health issues. Adaptations were mandatory to maintain services and explore new areas of activity to supply the low demand for cosmetic surgery during the crisis.

Keywords:
Coronavirus infections; Pandemics; Socioeconomic factors; Quality of life; Surgery, plastic

Demographic Block		No	%	p -value
P03	What is your age? <30 years	2	0.7	<0.001
	30 - 35 years	25	9.3	0.002
	36 - 40 years	48	17.9	0.823
	41 - 45 years	50	18.7	Ref.
	46 - 50 years	37	13.8	0.128
	51 - 55 years	30	11.2	0.015
	56 - 60 years	22	8.2	<0.001
	61 - 65 years	33	12.3	0.042
	66 - 70 years	14	5.2	<0.001
	> 70 years	7	2.6	<0.001
P04	What’s your sex?
	Female	130	20.1
	Male	515	79.9	<0.001
P05	How long have you been working as a Plastic Surgeon?
	<5 years	110	17	<0.001
	5-10 years	109	16.9	<0.001
	10-20 years	185	28.7	<0.001
	>20 years	241	37.4	<0.001
P06	In which state of Brazil do you currently operate?
	Midwest	81	12.5	<0.001
	Northeast	82	12.7	<0.001
	North	16	2.5	<0.001
	Southeast	341	52.9	Ref.
	South	125	19.4	<0.001
P07	In which sector do you work?
	Both services	251	38.9	<0.001
	Private service	388	60.2	Ref.
	Public service	6	0.9	<0.001
Emotional Block		N	%	p -valor
P28	Did you use any psychiatric medication that you did not use previously during the pandemic?
	No	597	92.5	<0.001
	Yes	48	7.4	<0.001
P29	Have you felt mentally overwhelmed at any point this year due to the COVID-19 pandemic?
	No	194	30.1	<0.001
	Yes	451	69.9
P30	Have you started any exercise/sports/healthy habits routine that you did not do prior to the pandemic?
	No	430	66.7	<0.001
	Yes	215	33.3	<0.001
P31	Have you SUSPENDED any exercise/sports/healthy habits routine you performed before the pandemic?
	No	252	39.1	<0.001
	Yes	393	60.9
Contamination Block		N	%	p -valor
P10	Do any of the services you work as a plastic surgeon serve COVID-19+ patients?
	No	239	37.1	<0.001
	Yes	406	62.9	<0.001
Contamination Block		N	%	p -valor
P11	Do you work directly with COVID19+ patients?
	No	479	74.2	<0.001
	Yes. Approach to pressure injuries.	51	7.9	<0.001
	Yes. Urgent surgeries in patients without a confirmed diagnosis.	31	4.8	<0.001
	Yes. Oncological surgeries.	56	8.7	<0.001
	Yes. Care in ICU, SAMU and field hospitals.	28	4.4	<0.001
P19	Have you been affected by COVID 19?
	No.	590	91.5	Ref.
	Yes. Asymptomatic form (positive exams only).	19	2.9	<0.001
	Yes. Mild symptomatic form (home treatment).	36	5.6	<0.001
P20	Have you returned to your elective office activities? I did not return to activities.	99	15.3	<0.001
	I never stopped.	51	7.8	<0.001
	Yes. I have returned.	495	76.8	Ref.
P21	If you have already returned, how many days have you been stopped?
	I still have not returned to activities.	77	11.8	<0.001
	Up to 7 days.	45	7.0	<0.001
	7-14 days.	45	7.0	<0.001
	14-21 days.	54	8.4	<0.001
	21-30 days.	65	10.1	<0.001
	>30 days.	359	55.7	Ref.
Block Changes		N	%	p -valor
P12	Has the COVID-19 pandemic reduced your workload (within the field of Plastic Surgery)?
	No. There was an increase in the volume of work.	3	0.5	<0.001
	No. The volume remained constant.	8	1.2	<0.001
	Yes, but only in the private service.	46	7.1	<0.001
	Yes, but only in public service.	5	0.8	<0.001
	Yes. There was a reduction in the volume of work.	583	90.4	Ref.
P13	Was there an institutional restriction of ELECTIVE plastic surgeries in your service?
	No.	42	6.5	<0.001
	Yes, but only in the private service.	33	5.1	<0.001
	Yes, but only in public service.	17	2.6	<0.001
	Yes.	553	85.7	Ref.
P14	Was there an institutional restriction on URGENCY plastic surgery in your service?
	No.	451	69.8	Ref.
	Yes, but only in the private service.	29	4.5	<0.001
	Yes, but only in public service.	28	4.4	<0.001
	Yes.	137	21.2	<0.001
P15	Concerning March-April/2019, what was the percentage of REDUCTION of elective surgeries observed in YOUR practice for the same period in 2020?
	There was an increase in elective surgical procedures.	10	1.6	<0.001
	I do not perform elective surgical procedures	3	0.5	<0.001
	<30%	14	2.1	<0.001
	30-60%	64	9.9	<0.001
	60-90%	237	36.7	<0.001
	>90%	317	49.1	<0.001
Block Changes		N	%	p -valor
P16	Concerning March-April/2019, what was the percentage of REDUCTION of NON-SURGICAL procedures (Botox/fillers/etc.) observed in YOUR practice for the same period in 2020?
	There was an increase in the number of non-surgical procedures	17	2.6	<0.001
	I do not perform non-surgical procedures	81	12.5	<0.001
	<30%	18	2.9	<0.001
	30-60%	80	12.4	<0.001
	60-90%	171	26.5	<0.001
	>90%	278	43.2	<0.001
P17	Your operating costs (rents/office/secretary/suppliers) remained constant during the Pandemic?
	No. They increased.	8	1.2	<0.001
	No. They have been reduced.	177	27.4	<0.001
	Yes. They remained the same.	460	71.3	Ref.
P18	What was, on average, the percentage REDUCTION of your revenue due to the pandemic?
	<30%	35	5.4	<0.001
	30-60%	159	24.6	<0.001
	60-90%	279	43.3	<0.001
	>90%	172	26.6	<0.001
Prevention block		N	%	p -valor
P08	Was there a measure of social isolation in your main city of operation?
	No	2	0.3	<0.001
	Yes	643	99.7	<0.001
P09	Was there LOCKDOWN in your main professional city?
	No	381	59	<0.001
	Yes	264	41	<0.001
P22	Are patients undergoing surgery at your service tested for COVID-19 using any method?
	No.	273	42.3	Ref.
	Yes. RT-PCR only.	151	23.4	<0.001
	Yes. Only serology.	108	16.7	<0.001
	Yes. Serology + RT-PCR.	113	17.5	<0.001
P23	Are your team members, or have they been tested for COVID-19 with any method before restarting activities?
	No.	374	58.0	Ref.
	Yes. RT-PCR only.	54	8.4	<0.001
	Yes. Only serology.	124	19.2	<0.001
	Yes. Serology + RT-PCR.	93	14.4	<0.001
P24	In the face-to-face care of your patients, has there been a change in the care routine? (More than one option available)
	No.	4	0.6	<0.001
	Yes. Disposable apron	93	14.4	<0.001
	Yes. Face shield	116	18.0	<0.001
	Yes. Mask and alcohol-gel	603	93.5	Ref.
	Yes. Mask N95/similar.	190	29.5	<0.001
P25	In elective surgeries, were clauses about COVID-19 included in the surgical consent form?
	No.	70	12.1	<0.001
	No.	70	12.1	<0.001
P26	Have you used teleconferencing and/or social media (including WhatsApp) to serve patients during the pandemic?
	No.	211	32.7	<0.001
	Yes.	434	67.3	<0.001
P27	Were you already using teleconferencing and/or social media (including WhatsApp) to serve patients before the pandemic?
	No.	346	53.6	0.009
	Yes	299	46.4	0.009

Region	South	Southeast	Midwest	North	Northeast	BRAZIL
Answers	125 (19.4%)	341 (52.9%)	81 (12.5%)	16 (2.5%)	82 (12.7%)	645
Sex	80%M : 20% F	81%M : 19%F	80%M : 20%F	100%M	68%M : 32%F	79.9%M : 20.1%F
Service in which you operate Private SUS Both	68.8% 0.8% 30.4%	61.6% 0.9% 37.5%	61.7% - 38.3%	50% - 50%	41.5% 2.4% 56.1%	60.2% 0.9% 38.9%
Training time
<5 years 5-10 years 10-20 years >20 years	12.8% 16% 32% 39.2%	16.7% 13.5% 29% 40.8%	30.9% 21% 23.4% 24.7%	12.5% 31.25% 31.25% 25%	12.2% 25.6% 26.8% 35.4%	17% 16.9% 28.7% 37.4%
Isolation rate	100%	99.4%	100%	100%	100%	99.7%
Lockdown rate	43.2%	30.8%	37%	68.7%	57.3%	41%
Covid-19+ No Yes, asymptomatic Yes, symptomatic	96.8% 1.6% 1.6%	90% 3.2% 6.8%	97.5% - 2.5%	75% - 25%	86.6% 7.3% 6.1%	91.5% 2.9% 5.6%
Institutional restriction on elective surgeries	92.8%	93.8%	90.1%	93.8%	96.3%	993.4%
Institutional restriction on emergency surgeries	25.6%	34.6%	18.5%	25%	31.7%	30.1%

Region	South	Southeast	Midwest	North	Northeast	BRAZIL
Return to activities	92.8%	81.2%	98.7%	67.8%	75.6%	76.8%
Downtime
<7 days	3.2%	7.6%	11.1%	-	7.3%	7%
7-14 days	10.4%	4.8%	14.8%	6.25%	2.4%	7%
14 - 21 days	11.2%	7%	12.4%	6.25%	6.1%	8.4%
21 - 30 days	16.8%	9.3%	11.1%	---	4.9%	10.1%
>30 days	52%	56.9%	50.6%	68.75%	58.6%	55.7%
Did not return	6.4%	14.4%	---	18.75%	20.7%	11.8%
↓ Elective surgeries
<30%	3.2%	4.7%	2.5%	-	2.4%	4.2%
30-60%	16.8%	5.3%	27.2%	6.25%	2.4%	9.9%
60-90%	48%	33.7%	50.6%	18.75%	35.4%	36.7%
>90%	32%	56.3%	19.7%	75%	59.8%	49.1%
↓ Non-surgical procedures
Does not perform	14.8%	12.3%	6.2%	25%	13.4%	12.5%
<30%	5.9%	15%	7.4%	---	3.7%	5.4%
30-60%	17.3%	7%	25.9%	12.5%	3.6%	12.4%
60-90%	38%	20.4%	33.3%	18.75%	23.3%	26.5%
>90%	24%	45.3%	27.2%	43.75%	56%	43.2%
↓ Net Revenue
<30%	5.8%	5.3%	8.8%	-	6.1%	5.4%
30-60%	29.9%	19.5%	34.2%	18.75%	26.8%	24.6%
60-90%	45.3%	43.8%	48.1%	43.75%	35.4%	43.3%
>90%	19%	31.4%	8.9%	37.5%	31.7%	26.6%

	<10 years of graduation (n=220)		>10 years of graduation (n=425)
Service	Number of responses	Percentage	Number of responses	Percentage
Private SUS Both	124 3 93	56.4% 1.4% 42.2%	264 3 158	62.1% 0.7% 37.2%
Where you work as a plastic surgeon, do you attend COVID-19?
Yes	152	69.1%	254	59.8%
No	68	30.9%	171	40.2%
Do YOU work directly with COVID-19? Yes Urgent, oncological, reparative and pressure injuries surgeries SAMU, ICU, field hospitals No	83 66 17 137	37.7% 30% 7.7% 62.3%	83 72 11 342	19.5% 16.9% 2.6% 80.5%
Affected by COVID-19?
Yes	30	13.7%	25	5.9%
No	190	86.3%	400	94.1%
Did you feel mentally overwhelmed? Yes No	160 60	72.7% 27.3%	291 134	68.5% 31.5%
Did you use new psychiatric medication in the pandemic?
Yes	17	7.7%	31	7.3%
No	203	92.3%	394	92.7%
Did you start new physical activity during the pandemic? Yes No	66 154	30% 70%	149 276	35% 65%
Did you suspend physical activity during the pandemic?
Yes	145	65.9%	248	58.4%
No	75	34.1%	177	41.6%
↓ Net Revenue <30%	18	8.2%	17	4%
30-60%	75	34.1%	84	19.8%
60-90%	94	42.7%	185	43.5%
>90%	33	15%	139	32.7%

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E-mail: rbcp@cirurgiaplastica.org.br

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[1] Conflicts of interest: none.