Neurosurgery subspecialty practice during a pandemic: a multicenter analysis of operative practice in 7 U.S. neurosurgery departments during COVID-19.

Overview

abstract

OBJECTIVE: Changes to neurosurgical practices during the COVID-19 pandemic have not been thoroughly analyzed. We report the effects of operative restrictions imposed under variable local COVID-19 infection rates and healthcare policies using a retrospective multi-center cohort study and highlight shifts in operative volumes and subspecialty practice. METHODS: Seven academic neurosurgery departments' neurosurgical case logs were collected; procedures in April 2020 (COVID-19 surge) and April 2019 (historical control) were analyzed overall and by 6 subspecialties. Patient acuity, surgical scheduling policies, and local surge levels were assessed. RESULTS: Operative volume during COVID-19 decreased 58.5% from the previous year (602 vs 1449, p=0.001). COVID-19 infection rates within departments' counties correlated with decreased operative volume (r=0.695, p=0.04) and increased patient categorical acuity (p=0.001). Spine procedure volume decreased by 63.9% (220 vs 609, p=0.002), for a significantly smaller proportion of overall practice during the COVID-19 surge (36.5%) versus the control period (42.0%) (p=0.02). Vascular volume decreased by 39.5% (72 vs 119, p=0.01) but increased as a percentage of caseload (8.2% in 2019 vs 12.0% in 2020, p=0.04). Neuro-oncology procedure volume decreased by 45.5% (174 vs 318, p=0.04) but maintained a consistent proportion of all neurosurgeries (28.9% in 2020 vs 21.9% in 2019, p=0.09). Functional neurosurgery volume, which declined by 81.4% (41 vs 220, p=0.008), represented only 6.8% of cases during the pandemic versus 15.2% in 2019 (p=0.02). CONCLUSIONS: Operative restrictions during COVID-19 led to distinct shifts in neurosurgical practice, and local infective burden played a significant role in operative volume and patient acuity.