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

Abstract

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.

Keywords: Covid-19; Epidemic; Europe; Healthcare management; Neurosurgery; Pandemic; SARS-CoV-2.

Fig. 1

Bar plot showing proportion of centers that would offer surgery to the hypothetical cases in December and March. The cases are further described in methods, questionnaire, and results. Briefly, cases 1–3 reflect elective patients with surgically accessible diseases: a 75-year-old patient with glioblastoma, a 75-year-old patient with a convexity meningioma, and a 60-year-old patient with symptomatic cervical spinal stenosis. Cases 4–6 comprise patients with surgically accessible 60 cc lobar intracerebral hematomas; the patients are 75, 65, and 50 years old. Patient 7 has a severe subarachnoid hemorrhage with Hunt-Hess grade 4 and in need of external ventricular drainage

Fig. 2

a–c Expected time to surgery in December and March for the elective patients 1–3