Analysis of Neurosurgical Cases Before and During the Coronavirus Disease 2019 Pandemic from a Tertiary-Care Centre in India

Abstract

Objective We present the unique administrative issues as well as specific patient and surgeon related challenges and solutions implemented while treating neurosurgical cases during the COVID pandemic vis-à-vis the pre COVID times at our tertiary care center. Methods This is a retrospective study comparing the outcome of the neurosurgical patients treated from the beginning of lockdown in India on 25 March 2020 to 30 November 2020 with that of same period in the previous year, 2019. Results We had a total of 687 admissions under neurosurgery this year during the study period as compared to 2550 admissions in 2019. The total number of surgeries done under neurosurgery also showed a similar trend with only 654 surgeries in 2020 compared to 3165 surgeries in 2019. During COVID-19 times, a total of 474 patients were operated including both trauma and non-trauma cases. Out of the 50 COVID-19 suspect/ indeterminate patients who were operated upon, 5 patients turned out to be positive for COVID-19. Significant differences were seen in the mortality (p<0.01) and morbidity (p<0.01) among trauma patients on comparing COVID and pre-COVID periods. Similarly, a significant difference was observed in the mortality (p<0.001) and morbidity (p<0.001) in non-trauma patients. Conclusions A higher mortality and morbidity during the COVID times is primarily attributable to poorer baseline clinical status. Our experience in this COVID period might not only help us in tackling subsequent waves but also help other institutions in developing world to be better prepared for the same.

Practice Patterns in Surgical Neuro-Oncology Among Low- and Middle-Income Countries During the Coronavirus Disease 2019 Pandemic: A Scoping Review and Situational Report from the Philippines

“…Included studies were from India ( n = 6), 21 , 22 , 23 , 24 , 25 , 26 China ( n = 2), 19 , 20 Brazil ( n = 1), 18 Iran ( n = 1), 27 Turkey ( n = 1), 28 and multiple Asian countries (most from China). 29 Study types were case-control ( n = 6), 20 , 21 , 22 , 25 , 26 , 27 expert opinion and review ( n = 3), 18 , 23 , 28 cross-sectional survey ( n = 1), 29 retrospective cohort ( n = 1), 24 and letter to the editor with case report ( n = 1). 19 …”

“…Of these studies, 66.7% (6/9) reported decreases in caseloads ranging from 11.2% to 79.3%. 20 , 21 , 22 , 24 , 25 , 27 Of the 6 studies, 5 (83.3%) reported on the proportion of surgical neuro-oncologic compared with other types of cases. The proportions remained similar, ranging from 16.1% to 44% before the pandemic and 17.1% to 51.2% during the pandemic.…”

“…All studies used a triaging system to classify patients requiring surgery according to urgency. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 In general, emergent or urgent surgical treatment was recommended for patients with brain tumors with significant size and mass effect, malignant tumors, or those in herniation. Patients with benign asymptomatic tumors were deemed non- elective and had the least priority.…”

“…All studies recommended COVID-19 screening with reverse transcriptase polymerase chain reaction (RT-PCR) for all patients undergoing surgical neuro-oncology procedures. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 Two studies required a pulmonary high-resolution computed tomography (HRCT) scan in addition to the RT-PCR test. 18 , 27 One study recommended the use of a COVID-19 rapid antigen test in patients who needed acute and emergent treatment while waiting for the RT-PCR.…”

“…All studies were consistent in using level I PPE for COVID-19–negative patients and level III PPE for COVID-19–positive patients. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 …”