Current trends and outcomes of non-elective neurosurgical care in Central Europe during the second year of the COVID-19 pandemic

Abstract

Reflecting the first wave COVID-19 pandemic in Central Europe (i.e. March 16th–April 15th, 2020) the neurosurgical community witnessed a general diminution in the incidence of emergency neurosurgical cases, which was impelled by a reduced number of traumatic brain injuries (TBI), spine conditions, and chronic subdural hematomas (CSDH). This appeared to be associated with restrictions imposed on mobility within countries but also to possible delayed patient introduction and interdisciplinary medical counseling. In response to one year of COVID-19 experience, also mapping the third wave of COVID-19 in 2021 (i.e. March 16 to April 15, 2021), we aimed to reevaluate the current prevalence and outcomes for emergency non-elective neurosurgical cases in COVID-19-negative patients across Austria and the Czech Republic. The primary analysis was focused on incidence and 30-day mortality in emergency neurosurgical cases compared to four preceding years (2017–2020). A total of 5077 neurosurgical emergency cases were reviewed. The year 2021 compared to the years 2017–2019 was not significantly related to any increased odds of 30 day mortality in Austria or in the Czech Republic. Recently, there was a significant propensity toward increased incidence rates of emergency non-elective neurosurgical cases during the third COVID-19 pandemic wave in Austria, driven by their lower incidence during the first COVID-19 wave in 2020. Selected neurosurgical conditions commonly associated with traumatic etiologies including TBI, and CSDH roughly reverted to similar incidence rates from the previous non-COVID-19 years. Further resisting the major deleterious effects of the continuing COVID-19 pandemic, it is edifying to notice that the neurosurgical community´s demeanor to the recent third pandemic culmination keeps the very high standards of non-elective neurosurgical care alongside with low periprocedural morbidity. This also reflects the current state of health care quality in the Czech Republic and Austria.

A look at the global impact of COVID-19 pandemic on neurosurgical services and residency training

“…After removing duplicates, 935 articles were left; their titles and abstracts were screened, and 78 relevant articles were identified for full-text review. Overall, this study collated data and information from 49 articles, [ 11 , 12 , 17 , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] ] with 25 of them included in the quantitative synthesis ( Figure 1 ). Twenty-two of these articles were retrospective in nature, two had data collected both retrospectively and prospectively, one was both a retrospective cohort study and a survey.…”

“…Majority of the included studies observed a significant decrease in overall caseloads, both surgical and non-surgical, resulting in diminished clinical exposure for residents. [ 12 , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [30] , [31] , [32] , [33] , 35 , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] ] Ashry et al found that 56% of the residents had a reduction in their actual role in the surgical steps and the number of residents scrubbing in the same procedure had been decreased to the minimum for preservation of personal protective equipment (PPE). [21] A survey completed by El-Ghandour and colleagues revealed that elective surgery/clinic cancellation occurred more frequently in African countries and that theyr were utilizing PPE significantly less commonly in LMICs (OR=0.441, 95% CI 0.216-0.900, p <0.05).…”

Temporal trends in neurosurgical volume and length of stay in a public healthcare system: A decade in review with a focus on the COVID-19 pandemic

“…[ 4 ] With regard to the reductions seen in the “ Neuro-Oncology ” and “ Functional ” subspecialties, we suggest that this may be due to a decline in the number of craniotomies, occipital nerve, deep brain, and spinal cord stimulation. A reduced incidence of more chronic conditions, including spine conditions, hydrocephalus, and chronic subdural hematomas,[ 18 ] perhaps as a result of patient reluctance to present clinically, may have also contributed to our trends. However, uncertainty remains as we are unable to elicit whether the reductions seen across these three subspecialties are merely attributed to outliers seen between 2019 and 2020 and unrelated to the pandemic.…”

The Increased Mortality Rate with Lower Incidence of Traumatic Brain Injury during the COVID-19 Pandemic: A National Study

“…A similar finding was reported by Lara-Reyna [ 33 ]. On the contrary, a study from the Czech Republic and Austria showed no difference in all subgroups of patients treated for TBIs [ 34 ].…”

“…Official recommendations were [ 35 ] established [ 8 ] to maintain the emergency care system. The authors of two studies [ 23 , 34 ] concerned with the non-elective neurosurgical procedures in central and eastern Europe have shown no difference in volume during the pandemic.…”