Trends in Degenerative Lumbar Spinal Surgery During the Early COVID-19 Pandemic in Republic of Korea: A National Study Utilizing the National Health Insurance Database

Abstract

During the first year of the COVID-19 pandemic, the Republic of Korea (ROK) experienced three epidemic waves in February, August, and November 2020. These waves, combined with the overarching pandemic, significantly influenced trends in spinal surgery. The primary aim of this study was to investigate the trends in degenerative lumbar spinal surgery in ROK during the early COVID-19 pandemic, especially in relation to specific epidemic waves. The secondary aim was to compare surgical outcomes, including length of hospital stay (LOH), hospital costs, discharge disposition, the 30-day readmission rate, and the reoperation rate, between periods before and during the pandemic. A retrospective analysis of ROK’s national health information database (NHID) was conducted on all patients who underwent surgery for degenerative lumbar spinal diseases. Two cohorts were established: pre-COVID-19 (January to December 2019) and COVID-19 (January to December 2020). Propensity score matching and joinpoint regression were utilized. During the first year of the COVID-19 pandemic, the number of surgeries decreased following the first and second epidemic waves (p < 0.01 and p = 0.21, respectively), but these were offset by compensatory increases later on (both p < 0.01). However, the third epidemic wave did not lead to a decrease in surgical volume, and the total number of surgeries remained comparable to the period before the pandemic. LOH was reduced by 1 day (p < 0.01), while mean hospital costs increased significantly from 3,472 to 4,042 USD (p < 0.01). Additionally, both the transfer rate and the 30-day readmission rate significantly decreased (both p < 0.01), while the reoperation rate remained stable (p = 0.73). Despite the substantial impact of the early epidemic waves on degenerative lumbar spinal surgery, the overall number of operations and surgical outcomes during the early COVID-19 pandemic were comparable to pre-pandemic levels. These findings suggest that lumbar spinal surgery may not need to halt due to a pandemic. These insights should be widely disseminated to inform and guide future strategies in managing similar health crises.