The COVID-19 Pandemic and Plastic Surgery: Literature Review, Ethical Analysis, and Proposed Guidelines.

BACKGROUND: COVID-19, known as the "coronavirus", has spread to over 170 countries. In response, many organizations have spoken out and called to cancel all elective surgical procedures. OBJECTIVE: Our study aimed to provide clear recommendations for plastic surgeons to follow by addressing the following issues: 1) What defines elective surgery, and where does one draw the line between essential versus nonessential services? 2) How does this differ in the hospital versus private practice setting? 3) If called upon to operate on a patient with COVID-19, how do plastic surgeons protect themselves, while still providing excellent medical care? METHODS: A PRISMA systematic review of the literature on plastic surgery in the setting of a pandemic was performed on March 19, 2020. An ethical analysis was conducted using the four principles of medical ethics. RESULTS: The initial search yielded 118 articles. Eighteen articles were relevant and included for analysis. Only one editorial article was published in a plastic surgery journal. Accordingly, no peer-reviewed published COVID-19 guidelines exist for plastic surgery. Given that this pandemic may place healthcare systems under undue stress with an unpredictable trajectory, it is the responsibility of the plastic surgeon to assess and postpone cases whenever possible to properly contribute to adequate resource allocation and patient safety measures. CONCLUSION: This article fills an important gap in the literature by addressing COVID19 and providing guidelines for upholding ethics and responsible resource allocation. By upholding these standards, plastic surgeons can do their part to help minimize the spread of this virus.