Triaging Spine Surgery and Treatment during the COVID-19 Pandemic

Rizkalla, James; Hotchkiss, W.R.; Clavenna, Andrew; Dossett, Andrew; Syed, Ishaq

doi:10.1016/j.jor.2020.06.015

Cited by 15 publications

(18 citation statements)

References 39 publications

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“… 1 A three-tier classification system was created to triage the need for spinal surgery into elective, urgent or emergent cases. 11 Elective procedures where pain and dysfunction can be managed through non-operative measures were suspended. 1 Pathologies including adolescent idiopathic scoliosis, degenerative disc disease and stable isthmic spondylolisthesis were assessed as being low priority and postponed indefinitely.…”

Section: Referrals and Triagementioning

confidence: 99%

The impact of the COVID-19 pandemic on spinal surgery

Wordie¹

2021

Orthopaedics and Trauma

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Section: Referrals and Triagementioning

confidence: 99%

The impact of the COVID-19 pandemic on spinal surgery

Wordie¹

2021

Orthopaedics and Trauma

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“…These decisions can be made more difficult in instances where postponing surgical spine treatment can lead to poorer recovery or irreversible neurological damage. Risk factors such as the contraction of COVID-19 postoperatively and the possibility of this delaying recovery need to be taken into account; minimizing the risk of a patient contracting COVID-19 in a hospital setting, namely, elderly patients who are most at risk for severe disease or death, should be considered by the surgeon [5]. Many hospitals have been developing protocols that stratify the urgency of specific cases.…”

Section: Introductionmentioning

confidence: 99%

“…Cases that are deemed a level 4 priority indicate that the patient would be at an immediate risk for permanent disability or severe harm without surgery and indicate a need for immediate surgical intervention [10]. An accepted treatment protocol in the United States for spinal cord injury, which would render a case emergent, follows a suggested 8-24hour surgical intervention time window for the best recovery results [5]. A level 3 case indicates that a patient has failed previous medical management of their condition and would face a prolonged stay/increased chance of another hospital admission if a delay in surgery occurred.…”

Section: Introductionmentioning

confidence: 99%

“…A level 3 case indicates that a patient has failed previous medical management of their condition and would face a prolonged stay/increased chance of another hospital admission if a delay in surgery occurred. Cases deemed urgent do not currently have a clear exact recommended timing of surgical intervention in the United States, although these cases are considered in need of prompt intervention, more so than levels 0-2 but not as immediate as level 1 cases [5]. Finally, level 2 surgeries are considered semiurgent, where a delay past three months would put the patient at a risk of harm, and a case considered level 1 indicates that a delay past six months would not put a patient at risk of harm [10].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

COVID-19: Moral and Ethical Implications for Orthopaedic Spine Surgeons

Min

Iturriaga

Wang

et al. 2021

Case Reports in Orthopedics

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The rapid spread of COVID-19 has made a significant impact on healthcare systems worldwide, with a large influx of patients prompting the cancellation of elective surgery in order to conserve resources and prevent the risk of exposure to the novel virus. In this case report, we present a 66-year-old male patient, with a history of cerebral palsy and developmental disabilities, exhibiting an increasing loss of function over the course of 10 days amid the COVID-19 pandemic. The patient was initially refused transport to the hospital by emergency medical services and later transported per independent request from his surgeon. Upon admittance to the hospital, the patient was found to have severe spinal cord compression with myelopathic symptoms and underwent an anterior cervical discectomy and fusion. This case highlights the need for more specific guidelines regarding the evaluation of a spinal injury by EMS and the hospital system amid a national crisis.

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“…Deo et al [ 6 ] have described the challenges to tumor surgery arising from the COVID-19 pandemic and proposed corresponding guidelines, with the dynamics of the pandemic, available resources, patient characteristics, and the stage of the disease being considered as key factors. Wilson et al [ 7 ], and Rizkalla et al [ 8 ] have developed recommendations for triaging spinal surgery during the COVID-19 pandemic. Neurosurgical emergencies at a German university hospital during the COVID-19 pandemic have recently been covered in an interesting report by Hecht et al [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

The Demand for Elective Neurosurgery at a German University Hospital during the First Wave of COVID-19

et al. 2020

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Background: Patients’ fear of the coronavirus disease 2019 (COVID-19) may delay inevitable treatment, putting potential benefits at risk. This single-center retrospective study aims to analyze temporal relationships of the first wave of the COVID-19 pandemic in Germany with the number of patients who sought and received elective neurosurgical treatment at a German university hospital. Methods: Daily outpatient numbers (ON) and elective procedures (EP) were recorded at our department between 1 January 2020 and 30 June 2020 (baseline: between 1 January 2019 and 30 June 2019). In patients who received EP, we recorded indication, outcome, and length of stay (LOS). Moving averages of ON (MAON) and of EP were calculated. Data on governmental action taken in response to the pandemic and on coronavirus-positive cases in Germany (CPCG) were superimposed. Exponential and arc tangent curves (ATC) were fitted to the absolute numbers of CPCG. Phase shifts were estimated, and Spearman’s rank correlation coefficient, rho, was calculated between the 2020 MAON and the derivative function of the fitted ATC (DFATC). Wilcoxon rank sum served as statistical test. Significance was assumed with p values of less than 0.05. Results: ON were significantly decreased in April 2020 as compared to April 2019 (p = 0.010). A phase shift between the German lockdown, the DFATC, and the decrease in MAON was not detected, while a phase shift of 10 days between the DFATC and the subsequent increase in MAON was detected. The DFATC was significantly negatively correlated (rho = −0.92, p < 0.0001) to the MAON until 31 March 2020, and, when shifted by 10 days, the DFATC was significantly negatively correlated (rho = −0.87, p < 0.0001) to the MAON from 01 April 2020. EP (p = 0.023), including the subset of non-oncological EP (p = 0.032), were significantly less performed in the first half of 2020 as compared to the first half of 2019. In March and April 2020, we conducted significantly more EP due to motor deficits (p = 0.0267, and less), visual disturbances (p = 0.0488), and spinal instability (p = 0.0012), and significantly less EP due to radicular pain (p = 0.0489), as compared to March and April 2019. LOS ranked significantly higher in patients who received cranial or spinal EP in March and April 2020 as compared to March and April 2019 (p = 0.0497). Significant differences in outcome were not observed. Conclusion: The beginning of the COVID-19 pandemic was correlated to an immediate and significant decrease in ON, and to a significant decrease in the number of EP performed. The subsequent increase in ON was delayed. Adequate measures to promote timely discharge of patients may become increasingly relevant as the pandemic proceeds. Although we observed a shift in the range of indications towards significantly more EP in patients with neurological deficiencies, care should be taken to avoid potentially deleterious delays of necessary elective treatment in future pandemic situations.

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Triaging Spine Surgery and Treatment during the COVID-19 Pandemic

Cited by 15 publications

References 39 publications

The impact of the COVID-19 pandemic on spinal surgery

The impact of the COVID-19 pandemic on spinal surgery

COVID-19: Moral and Ethical Implications for Orthopaedic Spine Surgeons

The Demand for Elective Neurosurgery at a German University Hospital during the First Wave of COVID-19

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