Impact of the COVID-19 Pandemic on Neurosurgical Practice at an Academic Tertiary Referral Center: A Comparative Study

Abstract

BACKGROUND: Neurosurgical services have been affected by the 2019 novel coronavirus disease (COVID-19) pandemic, and several departments have reported their experiences and responses to the COVID-19 crisis in an attempt to provide insights from which other impacted departments can benefit. The goals of this study were to report the load and variety of emergent/urgent neurosurgical cases after implementing the "Battle Plan" at an academic tertiary referral center during the COVID-19 pandemic and to compare these variables with previous practice at the same institution.-METHODS: The clinical data of all patients who underwent a neurosurgical intervention between March 23, 2020, and April 20, 2020, were obtained from a prospectively maintained database. Data of the control group were retrospectively collected from the medical records to compare the types of surgeries/interventions performed by the same neurosurgical service before the COVID-19 pandemic started.-RESULTS: Over a 4-week period during the COVID-19 pandemic, 91 patients underwent emergent, urgent, and essential neurosurgical interventions. Patient screening at teleclinics identified 11 urgent surgical cases. The implementation of the Battle Plan led to a significant decrease in the caseload, and the variation of cases by subspecialty was evident when compared with a control group comprising 214 patients.-CONCLUSIONS: Delivery of optimal care and safe practice and education at an academic neurosurgical department can be well maintained with proper execution of crisis protocols. Teleclinics proved to be efficient in screening patients for urgent neurosurgical conditions, but in-person clinic visits may still be necessary for some cases in the immediate postoperative period.

Letter to the Editor: “The Return Back to Typical Practice from the ‘Battle Plan’ of the Coronavirus Disease 2019 (COVID-19) Pandemic: A Comparative Study”

“…In the initial days of the pandemic, medical and surgical societies worldwide prepared guidelines and adopted protocols to ensure safe health care delivery. 2 , 3 , 4 , 5 This study, which was conducted over 4 weeks, found that the number of neurosurgical interventions did eventually increase in the post-battle plan period, with a particular surge in functional neurosurgery and neuro-oncosurgery. 1 …”

In Reply to the Letter to the Editor Regarding “The Return Back to Typical Practice from the ‘Battle Plan’ of the COVID-19 Pandemic: A Comparative Study”

“…During the month reported from the COVID-19 “battle plan” era, we performed 2 neurosurgical endoscopic endonasal procedures (2.2% of all surgical procedures). 5 After the discontinuation of our “battle plan,” in the post-COVID period now encompassing 3 months, we have performed 16 neurosurgical endoscopic endonasal procedures (3.3% of all surgical procedures). For comparison, a control group composed of patients who had undergone neurosurgical intervention during a 6-month period (January 1 to June 30, 2019) was retrospectively collected from the medical records and averaged to a 3-month period.…”

“…In this cohort of a “typical” volume, 17 neurosurgical endoscopic endonasal procedures (2.6% of all neurosurgical procedures) had been performed within 3 months. 1 , 5 …”

Letter to the Editor Regarding: “Case Volumes and Perioperative COVID-19 Incidence in Neurosurgical Patients During a Pandemic: Experiences at Two Tertiary Care Centers in Washington, DC”

“… 4 Many other studies have shown a similar reduction in neurosurgical operative case volumes. 5 , 6 , 7 Dowlati et al. 1 reported a 50.1% decrease in operative cases and a 23.9% decrease in neurointerventional cases during the peak period of lockdown at 2 tertiary neurosurgical centers in the United States.…”

“…The significant decrease in spine and functional neurosurgical cases is consistent with the findings reported by other studies. 5 , 7 , 8…”