Spine surgery during COVID-19

Introduction: The COVID-19 pandemic has become the most prominent event of 2020, posing major challenges to both society and politics. Many surgical departments had to be restructured with more or less vague recommendations to be prepared for the feared onslaught of COVID-patients. This work served to capture the daily routine of spine surgery during the Corona pandemic. Patients & Methods: An online questionnaire with 32 questions about professional and personal daily life was sent to members of neurosurgical and spine surgical societies in the DACH region during the initial lockdown. Results: Daily professional life was very similar for a large proportion of respondents. Outpatient clinics were reduced to a minimum and replaced by telemedical care. Intra-departmental meetings were greatly reduced and employees were divided into „split teams“. The operative program was organized very differently in the DACH region. 92% of respondents reported that semi-acute or acute procedures had been postponed, while 6% of respondents were only able to perform emergency surgeries. Conclusion: Despite the lack of guidelines and almost daily changing policy guidance, many departments in the DACH region demonstrated very similar courses of action to contain nosocomial infections and prepare for the onslaught of COVID-patients. The lack of resources (masks, gloves, etc.) led to a further restriction of the surgical program in order to be able to continue to provide the basic equipment for effective work of medical staff. In light of future medical crises, this problem should be addressed in the future and consequently better organized.

A snapshot of European neurosurgery December 2019 vs. March 2020: just before and during the Covid-19 pandemic.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or Covid-19), which began as an epidemic in China and spread globally as a pandemic, has necessitated resource management to meet emergency needs of Covid-19 patients and other emergent cases. We have conducted a survey to analyze caseload and measures to adapt indications for a perception of crisis. METHODS: We constructed a questionnaire to survey a snapshot of neurosurgical activity, resources, and indications during 1 week with usual activity in December 2019 and 1 week during SARS-CoV-2 pandemic in March 2020. The questionnaire was sent to 34 neurosurgical departments in Europe; 25 departments returned responses within 5 days. RESULTS: We found unexpectedly large differences in resources and indications already before the pandemic. Differences were also large in how much practice and resources changed during the pandemic. Neurosurgical beds and neuro-intensive care beds were significantly decreased from December 2019 to March 2020. The utilization of resources decreased via less demand for care of brain injuries and subarachnoid hemorrhage, postponing surgery and changed surgical indications as a method of rationing resources. Twenty departments (80%) reduced activity extensively, and the same proportion stated that they were no longer able to provide care according to legitimate medical needs. CONCLUSION: Neurosurgical centers responded swiftly and effectively to a sudden decrease of neurosurgical capacity due to relocation of resources to pandemic care. The pandemic led to rationing of neurosurgical care in 80% of responding centers. We saw a relation between resources before the pandemic and ability to uphold neurosurgical services. The observation of extensive differences of available beds provided an opportunity to show how resources that had been restricted already under normal conditions translated to rationing of care that may not be acceptable to the public of seemingly affluent European countries.