The effect of COVID-19 on trainee operative experience at a multihospital academic neurosurgical practice: A first look at case numbers

Abstract

Background: COVID-19 has had a significant impact on the economy, health care, and society as a whole. To prevent the spread of infection, local governments across the United States issued mandatory lockdowns and stay-at-home orders. In the surgical world, elective cases ceased to help “flatten the curve” and prevent the infection from spreading to hospital staff and patients. We explored the effect of the cancellation of these procedures on trainee operative experience at our high-volume, multihospital neurosurgical practice. Methods: Our department cancelled all elective cases starting March 16, 2020, and resumed elective surgical and endovascular procedures on May 11, 2020. We retrospectively reviewed case volumes for 54 days prelockdown and 54 days postlockdown to evaluate the extent of the decrease in surgical volume at our institution. Procedure data were collected and then divided into cranial, spine, functional, peripheral nerve, pediatrics, and endovascular categories. Results: Mean total cases per day in the prelockdown group were 12.26 ± 7.7, whereas in the postlockdown group, this dropped to 7.78 ± 5.5 (P = 0.01). In the spine category, mean cases per day in the prelockdown group were 3.13 ± 2.63; in the postlockdown group, this dropped to 0.96 ± 1.36 (P < 0.001). In the functional category, mean cases per day in the prelockdown group were 1.31 ± 1.51, whereas in the postlockdown group, this dropped to 0.11 ± 0.42 (P < 0.001). For cranial (P = 0.245), peripheral nerve (P = 0.16), pediatrics (P = 0.34), and endovascular (P = 0.48) cases, the volumes dropped but were not statistically significant decreases. Conclusion: The impact of this outbreak on operative training does appear to be significant based solely on statistics. Although the drop in case volumes during this time can be accounted for by the pandemic, it is important to understand that this is a multifactorial effect. Further studies are needed for these results to be generalizable and to fully understand the effect this pandemic has had on trainee operative experience.

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

“…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).…”

“… [59] Some studies suggested restructuring their resident rotations to incorporate altered working patterns: Suryaningtyas et al proposed a 10-day on and 20-day-off model, whereas Khan et al reported a decrease in the resident coverage to one week-on service and one week-off hospital. [ 23 , 24 ] Fifth studies reported a formal reduction of resident presence, with a significant decrease in working hours and responsibility. [ 21 , 22 , 26 , [30] , [31] , [32] , 35 , 40 , 44 , 50 , [56] , [57] , [58] , 62 , 64 ] However, some residents experienced increased burdens and anxiety due to the extra work caused by the pandemic, including redeployment to help manage COVID-19 patients or COVID-related problems when needed.…”

“…These findings are expected given spine, functional, and skull base cases were relatively less likely to be emergent in comparison to neurosurgical oncology, neuro-trauma, neurovascular surgery, and pediatric neurosurgery service. [ 24 , 27 ] The disproportionate decrease in spine, functional, and skull base cases may carry significant implications for both the patients and the trainees. Delays in surgical intervention or adoption of a more conservative approach increases the risk of neurological deterioration, permanent loss of function, and treatment failure in these patient populations.…”

Impact of COVID‐19 on Otolaryngology Literature

“…This increase in research productivity was likely due to the pandemic's limiting effect on clinical practice, particularly elective procedures, of which the U.S. cancelled more than other countries. [27][28][29][30] Studies have demonstrated lower levels of evidence among COVID compared to non-COVID articles. Among the top medical journals, COVID publications were 186-fold more likely to be of lower evidence.…”