Perioperative Coronavirus Disease 2019 (COVID-19) Incidence and Outcomes in Neurosurgical Patients at Two Tertiary Care Centers in Washington, DC, During a Pandemic: A 6-Month Follow-up

Abstract

Objective Coronavirus disease 2019 (COVID-19) continues to affect all aspects of healthcare delivery and neurosurgical practices are not immune to its impact. We aim to evaluate neurosurgical practice patterns as well as perioperative incidence of COVID-19 in neurosurgical patients and their outcomes. Methods A retrospective review of neurosurgical and neurointerventional cases at two tertiary centers during the first three months of the first peak of COVID-19 pandemic (March 8-June 8) as well as following three months (post-peak pandemic; June 9-September 9) was performed. Baseline characteristics, perioperative COVID-19 test results, modified Medically Necessary Time Sensitive (mMeNTS) score, and outcome measures were compared between COVID-19 positive and negative patients through bivariate and multivariate analysis. Results 652 neurosurgical and 217 neurointerventional cases were performed during post-peak pandemic period. Cervical spine, lumbar spine, functional/pain, cranioplasty, and cerebral angiogram cases were significantly increased in the post-pandemic period. There was a 2.9% (35/1,197) positivity rate for COVID-19 testing overall and 3.6% (13/363) positivity rate postoperatively. Age, mMeNTS score, complications, length of stay, case acuity, ASA status, length of stay, and disposition were significantly different between COVID-19 positive and negative patients. Conclusion A significant increase in elective case volume during the post-peak pandemic period is feasible with low and acceptable incidence of COVID-19 in neurosurgical patients. COVID-19 positive patients were younger, less likely to undergo elective procedures, had increased length of stay, had more complications, and were discharged to a location other than home. The mMeNTS score plays a role in decision making for scheduling elective cases.

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

“…Eight studies reported the case volume of elective neurosurgical procedures performed both before and during the COVID-19 pandemic. [ 27 , [37] , [38] , [39] , [40] , 47 , 50 , 54 ] Collectively, the number of elective surgeries decreased by 70.4% (OR=0.296, 95% CI 0.210–0.418, p <0.001) ( Figure 2 A). A comparison of non-elective neurosurgical procedures was reported in 9 studies, with an overall decrease of 68.2% (OR=0.318, 95% CI 0.193–0.525, p <0.001) ( Figure 2 B).…”

“…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).…”

Letter to the Editor Regarding “Perioperative COVID-19 Incidence and Outcomes in Neurosurgical Patients at Two Tertiary Care Centers in Washington, DC, During a Pandemic: A 6-Month Follow-up”

“…Finally, it was observed that incidence rates remain low despite the increase in the volume of patients, which supports the effectiveness of general and specialized measures adopted in the different centers to minimize the spread of this disease. 1 We thank Sarpong et al. 1 for providing this valuable information.…”

“…We read with great interest the article published in your respected journal by Sarpong et al. 1 entitled “Perioperative COVID-19 Incidence and Outcomes in Neurosurgical Patients at Two Tertiary Care Centers in Washington, DC, During a Pandemic: A 6-month Follow-up,” where the authors evaluated the perioperative incidence of coronavirus disease 2019 (COVID-19) in neurosurgery patients, as well as their respective evolution. During their study, they obtained a perioperative incidence of COVID-19 of 5.4% at the peak of the pandemic and 2.9% in the postpeak period.…”