Two years of COVID-19 and its impact on volume of surgical spine care in Germany - a German Spine Registry (DWG) analysis

ABSTRACT

Background: The COVID-19 pandemic has largely affected spine care worldwide. At the beginning of the pandemic in Germany, surgical volume dropped markedly. Currently, it is unclear how surgical volume changed afterwards and especially during later pandemic waves. For this Registry study it was hypothesized that the COVID-19 pandemic in Germany is associated with a reduction of executed surgical spinal interventions, which was more prominent for specific spinal pathologies. Method(s) Surgical cases were selected from the German Spine Registry (DWG Register) during a 4-year period. Two groups were composed and compared. Patients enrolled prior to the start of the COVID-19 pandemic (before 01.01.2020) were included in group 'PRE-pandemic'. Patients admitted between 01.01.2020 and 31.12.2021 were selected for the group 'PANdemic'. We compared surgical volume over time and between groups. Subanalysis of specific pandemic waves and the impact on surgery foe specific spinal pathologies was studied as well. In order to optimize comparability, institutions that provided information during the entire study period were studied separately as well (adjusted analysis) Results: A total of 206841 patients have been identified. The prepandemic group included 89405 cases, whereas the PANDemic group had 117436 cases. A total of 142 institutions managed to include patients for this study (Fig.1a/b). As anticipated, monthly surgical volume did not differ between 2018 and 2019. However, an altered annual distribution pattern was seen in the pandemic years 2020 and 2021 Fig.2a/b). The additional adjusted analysis included 96 identical clinics. In parallel to pandemic waves, a drop in executed interventions was seen in the PANdemic group. Following the 1st pandemic wave, restoration of normal surgical volume took 3 months, whereas after later waves, normalization of surgical spine care occurred faster. Furthermore, following waves in 2021, a compensatory upsurge of surgical volume was seen. The most prominent reduction of surgical volume was seen in patients with degenerative diseases. In addition, a striking drop of performed interventions for critical categories such as infection and tumours occurred as well. Conclusion(s) The current study demonstrates that the COVID-19 pandemic is associated with decreased surgical load. However, restoration after pandemic waves occurs faster and more profound. Not only elective surgery rates dropped but also interventions for critical indications. During periods of peak COVID-19 incidences not only a decrease in performed elective surgeries was seen, but also the number of interventions for critical conditions dropped markedly. More protocols are required to optimize restoration of surgical volume after pandemic waves for different spine pathologies.