An Australian Response to the COVID-19 Pandemic and Its Implications on the Practice of Neurosurgery

Abstract

Objective: This study was designed to assess the impact of public health policy in Australia in response to the coronavirus disease identified in 2019 (COVID-19) pandemic on the delivery of neurosurgical services. Being essential services, we postulated that there would not be a decrease in elective and emergency neurosurgical presentations and surgeries.

Methods: This is a prospective, observational, epidemiologic study in strict adherence to the "STROBE" (Strengthening The Reporting of OBservational studies in Epidemiology) guidelines. It is a cross-sectional, multicentric study involving 5 tertiary neurosurgical centers to capture all public neurosurgical admissions in Queensland during the past 3 months (February-April, 2020) of significant public health policy changes to combat COVID-19.

Results: An analysis of the 1298 admissions for the Queensland population of 5.07 million Australians demonstrated a decrease in the number of elective and emergency admissions. The decline in elective admissions, particularly degenerative spine, benign neoplasms, and vascular pathologies, was a direct response of government strategy to curb activity to urgent surgical interventions only. Moreover, a trend toward fewer emergency admissions was also noted, partly explained by less trauma and also a decline in vascular pathologies including subarachnoid hemorrhage.

Conclusions: In comparison with Europe and North America, this study demonstrates the impact of proactive public health measures in Australia that successfully flattened the COVID-19 curve while facilitating ongoing care of acutely unwell neurosurgical patients.

Keywords: Australia; COVID-19; Neurosurgery; Public health; Subarachnoid hemorrhage.

Figure 1

Number of COVID-19 cases over time. This point plot demonstrates the incidence of confirmed COVID-19 cases in Queensland with a spike in mid-March, eventually plateauing in mid-April.

Figure 2

Distribution of age over time. This histogram helps appreciate the flattening of the distribution of age due to a decrease in the number of neurosurgical presentations among patients between 50 and 80 years of age.

Figure 3

Neurosurgical admissions in Queensland over 4 years. This point-plot demonstrates the steady pattern of neurosurgical admissions (500 ± 50) over the past 4 years with a dramatic decline in admissions during the COVID-19 pandemic.

Figure 4

Distribution of gender over time. The bar-plot demonstrates a slight preponderance of male patients that was preserved despite an overall decrease in neurosurgical presentations. The case mix was weighted heavily toward cranial pathologies.

Figure 5

Distribution of neurosurgical admissions over time based on etiology. The decline in elective presentations is accounted for by the decrease in degenerative pathologies, benign neoplasms, and vascular lesions in line with government directives. The decline in emergency presentations, although partly accounted for by the decrease in trauma, is also partly accounted for by the reduced number of vascular presentations. However, presentations from cerebrospinal fluid flow disorders remained steady.

Figure 6

Distribution of neurosurgical admissions over time based on site. While the elective cranial and spinal workload was reduced in line with government directives, the emergency spinal presentations appear more substantially reduced in comparison with cranial presentations.

Figure 7

Distribution of surgical intervention over time based on etiology. Surgical management, similar to overall admissions, demonstrated a significant decline in degenerative pathology; moderate decline in oncology and vascular surgeries; slight decline in trauma; and similar number of surgeries for cerebrospinal fluid flow disorders.

Figure 8

Distribution of surgical intervention over time based on site. Both elective and emergency surgeries were reduced with a more substantial decrease in spinal surgeries in comparison with cranial surgeries and an almost complete obliteration of surgeries of the peripheral nervous system.