Trends and outcomes for non-elective neurosurgical procedures in Central Europe during the COVID-19 pandemic

Abstract

The world currently faces the novel severe acute respiratory syndrome coronavirus 2 pandemic. Little is known about the effects of a pandemic on non-elective neurosurgical practices, which have continued under modified conditions to reduce the spread of COVID-19. This knowledge might be critical for the ongoing second coronavirus wave and potential restrictions on health care. We aimed to determine the incidence and 30-day mortality rate of various non-elective neurosurgical procedures during the COVID-19 pandemic. A retrospective, multi-centre observational cohort study among neurosurgical centres within Austria, the Czech Republic, and Switzerland was performed. Incidence of neurosurgical emergencies and related 30-day mortality rates were determined for a period reflecting the peak pandemic of the first wave in all participating countries (i.e. March 16th–April 15th, 2020), and compared to the same period in prior years (2017, 2018, and 2019). A total of 4,752 emergency neurosurgical cases were reviewed over a 4-year period. In 2020, during the COVID-19 pandemic, there was a general decline in the incidence of non-elective neurosurgical cases, which was driven by a reduced number of traumatic brain injuries, spine conditions, and chronic subdural hematomas. Thirty-day mortality did not significantly increase overall or for any of the conditions examined during the peak of the pandemic. The neurosurgical community in these three European countries observed a decrease in the incidence of some neurosurgical emergencies with 30-day mortality rates comparable to previous years (2017–2019). Lower incidence of neurosurgical cases is likely related to restrictions placed on mobility within countries, but may also involve delayed patient presentation.

Neurosurgical Care during the COVID-19 Pandemic in Central Germany: A Retrospective Single Center Study of the Second Wave

“…Interestingly, we could not register any changes in emergency cases, mortality, or night-shift surgery during the pandemic compared to the pre-pandemic time course. Despite this, a decrease in emergency neurosurgical cases, such as traumatic brain injuries, spine conditions, or chronic subdural hematomas, was noticed [18]. However, no decrease in neurosurgical emergencies or night procedures was evident in our study.…”

“…Furthermore, SSIs again emerged as the leading cause of readmissions. In the literature, SSIs were found repeatedly to be the most common reason for unplanned readmission [1,6,18]. The majority of unplanned readmissions in neurosurgery belong to the group of preventable readmission categories.…”

Trends in accident-related admissions to pediatric intensive care units during the first COVID-19 lockdown in Germany

“…Our data show a decline in admissions after traffic accidents and performed neurosurgeries, which might be related to each other. An international multicenter study recently showed the same trend for non-elective neurosurgeries in adults in Austria, Switzerland and the Czech Republic, that was partially driven by a decline in traumatic brain injuries (16).…”

Evaluation of anesthetic approaches to surgical patients during early COVİD-19 pandemic

“…In another study involving 153 emergency general surgery patients during the surge of COVID-19 pandemic, they found a 30-day mortality rate of 7% [26]. Grassner et al [27] examined emergency neurosurgical procedures during the first wave of the pandemic, they found that the 30day mortality did not increase compared to the previous 4 years (between 4,5%-8,9%). They stated that decreased incidence of neurosurgical emergency and this was related to the restrictions placed on mobility within countries [27].…”

“…Grassner et al [27] examined emergency neurosurgical procedures during the first wave of the pandemic, they found that the 30day mortality did not increase compared to the previous 4 years (between 4,5%-8,9%). They stated that decreased incidence of neurosurgical emergency and this was related to the restrictions placed on mobility within countries [27]. In our study, the mortality rates were seen as 8.3% in NS, 6.6% in GS, 3.8% in CVS and 2.7% in orthopedics.…”