Neurosurgical Referral Patterns During the Coronavirus Disease 2019 Pandemic: A United Kingdom Experience

Abstract

Background Coronavirus disease 2019 (COVID-19) is a severe respiratory viral illness that has spread rapidly across the world. However, the United Kingdom has been particularly affected. Evidence has suggested that stroke, cardiac, and spinal presentations decreased during the pandemic as the public avoided seeking care. The effect on neurosurgical presentations and referrals during COVID-19 is unclear. Our aim, therefore, was to describe the referral patterns to a high-volume neurosurgical department in the United Kingdom during the COVID-19 pandemic. Methods Electronic referrals were identified from the referrals database from January 1, 2020 to May 31, 2020, inclusive, with January used as the baseline. The demographic data and referral diagnoses were captured on Excel (Microsoft, Redmond, Washington, USA). Statistical analyses were performed using SPSS, version 22 (IBM Corp., Armonk, New York, USA). Differences between referral volumes were evaluated using χ 2 goodness-of-fit tests. Results A total of 2293 electronic referrals had been received during the study period. The median age was 63 years. Overall, the referrals had decreased significantly in volume during the study period [χ 2 (4) = 60.95; P < 0.001]. We have described the patterns in the daily referrals as the pandemic progressed. The reduction in the volume of referrals for degenerative spine cases and traumatic brain injuries was statistically significant ( P < 0.001). Conclusions The referrals for degenerative spine and traumatic brain injuries decreased significantly during the pandemic, which can be explained by the lower vehicular traffic and patient avoidance of healthcare services, respectively. The risk of neurological deterioration and increased morbidity and mortality, as a consequence, is of concern, and neurosurgeons worldwide should consider the optimal strategies to mitigate these risks as the pandemic eases.

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

“…The number of neuro-oncology cases and ruptured aneurysms also decreased, similar to the findings reported by Jayakumar et al. 1 The number of cerebrospinal fluid diversion procedures in our study had been the least affected by the COVID-19 pandemic.…”

“…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. No patients with degenerative spine had undergone surgery during the pandemic in our study, probably because such cases could easily be managed conservatively at home.…”

“…We appreciate and share the concern of Jayakumar et al. 1 for patients unable to receive the necessary hospital care because of the pandemic. 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.…”

“…We read with great interest the article by Jayakumar et al, 1 “Neurosurgical referral patterns during the COVID-19 pandemic: a United Kingdom experience.” This article provides a relevant insight into the effects of the coronavirus disease 2019 (COVID-19) pandemic on the pattern of neurosurgical referrals at the authors’ institution, a level I trauma center in the northeast of England, which serves a population of >3 million people. The United Kingdom was under a nationwide lockdown from March 23 to May 13, 2020.…”

“…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.…”