Neurosurgical Practice During the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic: A Worldwide Survey

Abstract

Background and objective: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has consistently changed medical practice throughout specialties, regardless of their contribution in facing the disease itself. We surveyed neurosurgeons worldwide to investigate the situation they are experiencing.

Methods: A 17-question, web-based survey was administered to neurosurgeons worldwide through the World Federation of Neurosurgical Societies and the Neurosurgery Cocktail from March 28 to April 5, 2020, by web link or e-mail invitation. Questions were divided into 3 subgroups: general information, health system organization, and institutional plans for the SARS-CoV-2 outbreak. Collected data were initially elaborated using SurveyMonkey software. Country-specific data were extracted from the World Health Organization website. Statistical analysis was performed using R, version 3.6.3.

Results: Of the 446 respondents, most were from Italy (20%), India (19%), and Pakistan (5%). Surgical activity was significantly reduced in most centers (79%) and dedicated in-hospital routes were created for patients with SARS-CoV-2 (58%). Patient screening was performed only when there were symptoms (57%) and not routinely before surgery (18%). The preferred methods included a nasopharyngeal swab and chest radiograph. Health professionals were rarely screened (20%) and sometimes, even if SARS-CoV-2 positive, were asked to work if asymptomatic (26%). Surgical planning was changed in most institutions (92%), whereas indications were modified for nonurgent procedures (59%) and remained unchanged for subarachnoid hemorrhages (85%).

Conclusions: Most neurosurgeons worldwide reported work reorganization and practices that respond to current international guidelines. Differences in practice might be related to the perception of the pandemic and significant differences in the health systems. Sharing data and experiences will be of paramount importance to address the present moment and challenges in the near future.

Keywords: COVID-19; Neurosurgery; Survey.

Figure 1

Square pie chart with global number of responses by country.

Figure 2

Correlation between number of answers to the survey and incidence of coronavirus disease 19 by country. (A) Dot plot of number of answers to the survey and number of total severe acute respiratory syndrome coronavirus 2 infections during the period in which the survey was open. Each dot represents a country. Scattered dots indicate no correlation between incidence of disease and number of responses. (B) Deviation for each country of registered number of answers to the survey from the expected value. Blue bars indicate an excess of answers; red bars indicate a lack of answers.

Figure 3

The survey window includes different stages of coronavirus disease 19 (COVID-19) epidemics in different countries. Cumulative incidence curves of COVID-19 epidemics for each country, showing the epidemic stage in which the survey was compiled. Red and blue dots represent beginning and end of the survey window. Green dots represent the estimated beginning of health emergency based on individual answers to the survey. The start of the outbreak should be considered to be located at a time point overlaying the upward flection of the incidence curve (inflection point incidence growth).

Figure 4

Distribution of each country's response to the health emergency. (A) Bar chart of total number of new coronavirus disease 19 infections during the period in which the survey was open. (B) Bar chart of responses to Q4 (“Regarding Neurosurgical Department, has your Nation/Region adopted special measures to face severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] outbreak?”). (C) Barplot of responses to Q14 (“Do you modify surgical indications if the patient is SARS-CoV-2 positive for non-emergency surgery?”). (D) Bar chart of responses to Q16 (“Do you modify your modus operandi in treating aneurysmal subarachnoid hemorrhage?”). The numbers on each plot represent the percentage of the total number of registered answers for each question for each country.

Figure 5

Word cloud of answers to Q15 (“Do you modify surgical indications if the patient is severe acute respiratory syndrome coronavirus 2 positive for nonemergency surgery? If YES, please specify”). A word cloud is a population of words in which each is represented with different size according to its frequency.