Getting Neurosurgery Services Back on Its Feet: “Learning to Live” with COVID-19

Abstract

Background: Cancellation/postponement of ” non-emergent ” surgeries during coronavirus disease of 2019 (COVID-19) pandemic has created a huge backlog of patients waiting for surgery and has put them at risk of disease progression. We share our institute's policy and our department's attempt to resume ” non-emergent ” surgeries. Materials and Methods: We collected details of all patients operated under department of neurosurgery since the onset of COVID-19 pandemic in India and categorized them into ” lockdown ” and ” unlock ” groups for comparison. COVID-19 tests done in these patients were also analyzed. We also compared our surgical volume with the number of COVID-19 cases in the state. Results: One hundred and forty-eight patients (97 males, 51 females) with mean age of 37.8 years (range-2 months-82 years) underwent surgery in our department during the study period. The operative volume per week increased by 37% during the ” unlock ” period as compared to ” lockdown ” period. The proportion of elective/” non-emergent ” surgeries increased from 11.3% during ” lockdown ” to 34.7% during the ” unlock ” period ( P = 0.0037). During ” lockdown ” period, number of surgeries declined steadily as the number of COVID-19 cases rose in the state (rs(8) = −0.914, P = 0.000). Whereas there was a trend toward increased number of cases done per week despite increase in the number of cases in the state during the “ unlock ” period. During the ” unlocking ” process, in-patient department admissions and surgeries performed per month increased ( P = 0.0000) and this increase was uniform across all specialties. COVID-19 test was done (preoperatively or postoperatively) for all surgeries during ” unlock ” period compared to 12 (22.6%) surgeries during ” lockdown ” period. Three neurosurgery patients who underwent surgery during the ” unlock ” period tested positive for COVID-19. Conclusions: Our experience shows that proper evidence-based protocols, setting up of adequate COVID-19 testing facilities and provision of ample personal protective equipments are instrumental in re-starting “nonemergent” surgeries.