Collateral damage caused by COVID-19: Change in volume and spectrum of neurosurgery patients

Abstract

Background: There has been a dramatic change in the pattern of patients being seen in hospitals and surgeries performed during the ongoing COVID-19 pandemic. The objective of this study is to study the change in the volume and spectrum of surgeries performed during the ongoing COVID-19 pandemic compared to pre-COVID-19 era. Methods: Details of all patients who were operated under department of neurosurgery at our institute since the onset of COVID-19 pandemic in India were collected and compared to the same time period last year. The demographic profile, diagnosis, surgery performed, type of surgery (routine/emergency, cranial/ spinal and major/minor) in these two groups were compared. They were further categorized into various categories [neuro-oncology (brain and spine tumors), neuro-trauma (head injury and spinal trauma), congenital cases, degenerative spine, neuro-vascular, CSF diversion procedures, etc.] and compared between the two groups. Results: Our study showed a drastic fall (52.2%) in the number of surgeries performed during the pandemic compared to pre-COVID era. 11.3% of patients operated during COVID-19 pandemic were nonemergent surgeries compared to 57.7% earlier (p = 0.000). There was increase in proportion of minor cases from 28.8% to 41.5% (p = 0.106). The proportion of spinal cases decreased from 27.9% to 11.3% during the COVID-19 pandemic (p = 0.043). Conclusions: The drastic decrease in the number of surgeries performed will result in large backlog of patients waiting for 'elective' surgery. There is a risk of these patients presenting at a later stage with progressed disease and the best way forward would be to resume work with necessary precautions and universal effective COVID-19 testing.

Letter to the Editor Regarding “Neurosurgical Referral Patterns During the COVID-19 Pandemic: A United Kingdom Experience”

“…On analyzing our operative workload by specialty, a decrease in the number of cases was noted across all specialties compared with before the COVID-19 pandemic 4 in concordance with the findings reported by Jayakumar et al. 1 The number of neuro-trauma cases had decreased owing to the decreased number of road traffic accidents, which had resulted from the reduced vehicle movement during the lockdown.…”

“…Our operative workload reflected this change in nonemergent OPD volumes. 4 5 During the lockdown period in 2020 (March 25 to May 31, 2020), 53 surgeries (47 emergency and 6 routine) had been performed compared with 111 (47 emergency, 64 routine) during the same period in 2019. Furthermore, the number of surgeries performed per week had declined steadily as the number of COVID-19 cases increased in the state [rs(8) = −0.914; P = 0.000].…”

“…A risk exists of these patients presenting at a later stage with disease progression, resulting in a worse prognosis for these patients and more difficult cases to manage later for neurosurgeons. 1 , 4 , 6 , 7 , 14 Jayakumar et al. 1 have advised neurosurgical centers across the world to be ready for an increased demand on resources as referrals and operative volumes begin to increase once the COVID-19 pandemic has slowed.…”

Deployment of Neurosurgeons at the Warfront Against Coronavirus Disease of 2019 (COVID-19)

“…The authors analyzed our department data between March 25 and May 31, 2020 and compared with the same time period last year. 10 , 14 We observed that during these 10 weeks of pandemic in 2020, only 53 surgeries were performed compared with 111 during the same period last year, representing a decrease of 52.2%. The majority of cancelled/postponed cases were “routine/nonemergent.” In total, 11.3% patients operated during COVID-19 pandemic were nonemergent surgeries compared with 57.5% in the pre–COVID-19 era ( P = 0.000).…”

“…As a response to COVID-19 pandemic, hospitals and medical institutions have had to adapt to the “new normal” by doing widespread COVID-19 testing, 9 switching from a physical outpatient department to telemedicine, and rescheduling of “non-emergent” surgeries. 10 Hospitals have been forced to ration materials and human resources. Hospital beds, ventilators, and monitors are being reserved for patients with COVID-19.…”