Case Volumes and Perioperative Coronavirus Disease 2019 Incidence in Neurosurgical Patients During a Pandemic: Experiences at Two Tertiary Care Centers in Washington, DC

Abstract

Objective: The true incidence of perioperative coronavirus disease 2019 (COVID-19) has not been well elucidated in neurosurgical studies. We reviewed the effects of the pandemic on the neurosurgical case volume to study the incidence of COVID-19 in patients undergoing these procedures during the perioperative period and compared the characteristics and outcomes of this group to those of patients without COVID-19.

Methods: The neurosurgical and neurointerventional procedures at 2 tertiary care centers during the pandemic were reviewed. The case volume, type, and acuity were compared to those during the same period in 2019. The perioperative COVID-19 tests and results were evaluated to obtain the incidence. The baseline characteristics, including a modified Medically Necessary Time Sensitive (mMeNTS) score, and outcome measures were compared between those with and without COVID-19.

Results: A total of 405 cases were reviewed, and a significant decrease was found in total spine, cervical spine, lumbar spine, and functional/pain cases. No significant differences were found in the number of cranial or neurointerventional cases. Of the 334 patients tested, 18 (5.4%) had tested positive for COVID-19. Five of these patients were diagnosed postoperatively. The mMeNTS score, complications, and case acuity were significantly different between the patients with and without COVID-19.

Conclusion: A small, but real, risk exists of perioperative COVID-19 in neurosurgical patients, and those patients have tended to have a greater complication rate. Use of the mMeNTS score might play a role in decision making for scheduling elective cases. Further studies are warranted to develop risk stratification and validate the incidence.

Keywords: COVID-19; Neurointerventional; Neurosurgery; Pandemic response; Severe acute respiratory syndrome coronavirus 2.

Figure 1

Timeline of coronavirus disease 2019 (COVID-19) pandemic in Washington, DC, with portrayal of study timeline starting March 8, 2020 (coinciding with the first COVID-19 diagnosis in Washington, DC) and ending 3 months later (June 8, 2020). Line graph showing inpatient census of COVID-19–positive patients at 2 tertiary care centers in Washington, DC, with the peak on April 30, 2020. Elective cases were cancelled starting March 18, 2020 and resumed for neurosurgery on June 1, 2020, coinciding with the Washington, DC, phase I reopening.

Figure 2

(A) Surgical case volume and (B) neurointerventional case volume comparing the 2020 pandemic period with the same period in 2019. Vertical dashed lines (March 18 and June 1) denote period in which elective cases were cancelled at these institutions. Peak coronavirus disease 2019 inpatient census noted as red mark on x axis (April 30, 2020).

Figure 3

(A) Surgical case volume stratified by case type comparing 2020 pandemic period with the same period in 2019. (B) The surgical cases for the first 3 months of the pandemic in 2020 and same period in 2019 were divided into spinal and cranial cases. Vertical dashed lines (March 18 and June 1) denote period in which elective cases were cancelled at these institutions. Peak coronavirus disease 2019 inpatient census noted as red mark on x axis (April 30, 2020). (C) Neurointerventional case volume stratified by case type comparing the 2020 pandemic period with the same period in 2019. ∗P < 0.05; ∗∗P < 0.01; ∗∗∗P < 0.001. AVM, arteriovenous malformation; CSF, cerebrospinal fluid; MMA, middle meningeal artery.

Figure 4

(A) Total surgical cases (P = 0.04) and (B) neurointerventional cases (P = 0.0701; NS) identified by acuity comparing 2020 pandemic period with the same period in 2019. ∗P < 0.05.

Figure 5

(A) Proportion of different race/ethnicities of patients identified with coronavirus disease 2019 (COVID-19) compared with that of patients without COVID-19 (P = 0.0059). (B) Length of stay (LOS) of COVID-19–positive versus–negative patients (mean and 95% confidence interval shown; 15.4 vs. 11.4 days; P = 0.0316). (C) Proportion of different disposition assignments of COVID-19–positive versus–negative patients (P = 0.0027). (D) Modified Medically Necessary Time Sensitive (mMeNTS) score for COVID-19–positive versus–negative patients (mean and 95% confidence interval shown; 9.8 vs. 8.4; P = 0.0013). ∗P < 0.05; ∗∗P < 0.01.