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Neurosurgery Subspecialty Practice During a Pandemic: A Multicenter Analysis of Operative Practice in 7 U.S. Neurosurgery Departments During Coronavirus Disease 2019.
Benner, Dimitri; Hendricks, Benjamin K; Elahi, Cyrus; White, Michael D; Kocharian, Gary; Albertini Sanchez, Leonardo E; Zappi, Kyle E; Garton, Andrew L A; Carnevale, Joseph A; Schwartz, Theodore H; Dowlati, Ehsan; Felbaum, Daniel R; Sack, Kenneth D; Jean, Walter C; Chan, Andrew K; Burke, John F; Mummaneni, Praveen V; Strong, Michael J; Yee, Timothy J; Oppenlander, Mark E; Ishaque, Mariam; Shaffrey, Mark E; Syed, Hasan R; Lawton, Michael T.
  • Benner D; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
  • Hendricks BK; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
  • Elahi C; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
  • White MD; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
  • Kocharian G; Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA.
  • Albertini Sanchez LE; Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA.
  • Zappi KE; Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA.
  • Garton ALA; Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA.
  • Carnevale JA; Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA.
  • Schwartz TH; Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA.
  • Dowlati E; Department of Neurosurgery, Georgetown University, Washington, DC, USA.
  • Felbaum DR; Department of Neurosurgery, Georgetown University, Washington, DC, USA.
  • Sack KD; Department of Neurosurgery, The George Washington University, Washington, DC, USA.
  • Jean WC; Department of Neurosurgery, The George Washington University, Washington, DC, USA.
  • Chan AK; Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA.
  • Burke JF; Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA.
  • Mummaneni PV; Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA.
  • Strong MJ; Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
  • Yee TJ; Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
  • Oppenlander ME; Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
  • Ishaque M; Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
  • Shaffrey ME; Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
  • Syed HR; Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
  • Lawton MT; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: neuropub@barrowneuro.org.
World Neurosurg ; 165: e242-e250, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1960086
ABSTRACT

OBJECTIVE:

Changes to neurosurgical practices during the coronavirus disease 2019 (COVID-19) pandemic have not been thoroughly analyzed. We report the effects of operative restrictions imposed under variable local COVID-19 infection rates and health care policies using a retrospective multicenter 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 the COVID-19 surge 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 the COVID-19 surge led to distinct shifts in neurosurgical practice, and local infective burden played a significant role in operative volume and patient acuity.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Neurosurgery Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: World Neurosurg Journal subject: Neurosurgery Year: 2022 Document Type: Article Affiliation country: J.wneu.2022.06.010

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Neurosurgery Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: World Neurosurg Journal subject: Neurosurgery Year: 2022 Document Type: Article Affiliation country: J.wneu.2022.06.010