Effects of the COVID-19 Pandemic on Spinal Fusion Procedures for Spinal Infections in a Nationwide Hospital Network in Germany

Abstract

Background The full impact of the COVID-19 pandemic on surgical spine care is difficult to assess due to a lack in nationwide evidence from more recent phases of the pandemic. We aimed to describe changes in in-hospital processes associated with spinal fusion procedures in the treatment of spinal infections (SI) during different phases of the pandemic. Methods In this retrospective observational study, we examined the in-hospital prevalence and outcomes of spinal fusion procedures for SI (along with patient characteristics, rates of transfer to intensive care units, and mortality rates) during the first four waves of the pandemic compared with the corresponding prepandemic periods in 2019. We used administrative data from a nationwide network of 76 hospitals managing 7% of all in-hospital cases in Germany. Results We observed no significant change in the prevalence of SI fusion procedures during the pandemic, neither in total numbers (349 vs. 373) nor for each wave separately. On a patient level, we found no differences in age, sex, and the prevalence of paresis, and no relevant differences in associated comorbidities. The rate of mechanical ventilation did not change during any of the examined pandemic waves: it ranged between 9.5 and 18.6% during the pandemic and 3.1 and 16.0% during the corresponding prepandemic control periods. The rate of transfer to intensive care changed only during wave 4 (from 70.4 to 54.8%; p = 0.046) but not in any other pandemic phases. We observed no changes in in-hospital mortality rates (range: 2.9–9.7% vs. 6.2–11.3%) or in duration of hospital stay (range: 26.2–30.8 days vs. 20.8–29.2 days). Conclusions The main finding of our study is that within this nationwide network of spine care centers in Germany, the delivery of surgical treatment of SI by means of spinal fusion procedures was maintained throughout the first four waves of the pandemic. Furthermore, there were no relevant changes in patient demographics, in-hospital processes, and mortality rates.

Neurosurgical patients' morbidity and mortality during the COVID-19 pandemic: An integrated review

“…Notably, despite the substantial prevalence of COVID-19 cases, there was no discernible deficit in intensive care capacity, even at the peak of the pandemic. This perception was consistent with the study conducted by Abduljawwad et al (2023), who examined 722 spine surgeries, revealing similar mortality rates from 2.9-9.7% during nonpandemic phases to 6.2-11.3% amid the pandemic. (2023) analyzed 6 months of both 2019 and 2020 in a Turkish university hospital, encompassing a total of 1,767 neurosurgical procedures.…”

The impact of SARS-CoV-2 measures on patient samples and complication rates in spine surgery – A single center analysis

“…It is such, that a trend towards higher numbers of emergency procedures during the SARS-CoV2 pandemic was observed. Comparing the two periods, a 10.2% increase in emergency operations was documented in the pandemic group which can be explained by the above-mentioned increased admission of emergency patients from smaller hospitals and is in line with findings by de Bock et al who reported an increase in the number of emergency surgeries during the COVID-19 outbreak and with Abduljawwad et al who reported no significant change in the prevalence of fusion procedures during the pandemic (7,17).…”

“…Several authors reported effects of the pandemic and its countermeasures on routine neurosurgical practice. While Chacon-Quesada et al reported a significant reduction of surgical site infections in their neurosurgical department due to the implemented measures; Abduljawwaad et al did not note any relevant changes in patient characteristics, duration of hospital stay and mortality rates in a nationwide network of spine care centers ( 6 , 7 ). An increased rate of complications in patients undergoing neurosurgery with concomitant SARS-CoV-2 infection has been by described by a group in Switzerland ( 8 ).…”

Decompressive Surgery in the Treatment of Acute Ischemic Stroke during the First Four Waves of the COVID-19 Pandemic in Germany: A Nationwide Observational Cohort Study

“…[6][7][8][9][10][11] The same studies also show that favorable outcomes, defined as modified Rankin scale scores of 0 to 3, are reached in 27% among those undergoing DS, compared with only 13% after conservative management. 10,12,13,20,22,24 A major drawback of DS in MMI patients is that, according to the existing evidence, high rates of disability after DS are especially apparent in patients older than 60 years, given that none of those achieve modified Rankin scale values lower than 3. 8,11 As a consequence of these studies, there is consensus that deciding for or against DS in MMI patients older than 60 years should be accompanied by individualized assessment of the overall medical condition, including the burden of comorbidity.…”

“…Helios is the largest private health care provider in Germany, managing 7% of all inhospital cases in Germany with presence in both urban and rural areas. The study period was subdivided into the following phases of the COVID-19 pandemic, according to cutoffs based on different waves in total numbers of COVID-19 hospitalizations within the hospital network 12,13 : leading up to wave 1 (January 1-March 12, 2020), wave 1 (March 13-May 25, 2020), between All phases of the study period were compared with the corresponding prepandemic phases in 2019 (control period). The primary diagnosis of AIS was established according to the International Statistical Classification of Diseases and Related Health Problems (ICD-10-GM [German modification]) codes using the main codes I63.0 to I63.9.…”