Collateral damage caused by COVID-19: Change in volume and spectrum of neurosurgery patients

Abstract

Background: There has been a dramatic change in the pattern of patients being seen in hospitals and surgeries performed during the ongoing COVID-19 pandemic. The objective of this study is to study the change in the volume and spectrum of surgeries performed during the ongoing COVID-19 pandemic compared to pre-COVID-19 era.

Methods: Details of all patients who were operated under department of neurosurgery at our institute since the onset of COVID-19 pandemic in India were collected and compared to the same time period last year. The demographic profile, diagnosis, surgery performed, type of surgery (routine/emergency, cranial/spinal and major/minor) in these two groups were compared. They were further categorized into various categories [neuro-oncology (brain and spine tumors), neuro-trauma (head injury and spinal trauma), congenital cases, degenerative spine, neuro-vascular, CSF diversion procedures, etc.] and compared between the two groups.

Results: Our study showed a drastic fall (52.2%) in the number of surgeries performed during the pandemic compared to pre-COVID era. 11.3% of patients operated during COVID-19 pandemic were non-emergent surgeries compared to 57.7% earlier (p = 0.000). There was increase in proportion of minor cases from 28.8% to 41.5% (p = 0.106). The proportion of spinal cases decreased from 27.9% to 11.3% during the COVID-19 pandemic (p = 0.043).

Conclusions: The drastic decrease in the number of surgeries performed will result in large backlog of patients waiting for 'elective' surgery. There is a risk of these patients presenting at a later stage with progressed disease and the best way forward would be to resume work with necessary precautions and universal effective COVID-19 testing.

Keywords: COVID-19 (coronavirus disease of 2019); COVID-19 testing; Elective surgeries; Emergency surgeries; India; Neurosurgical practice.

Fig. 1

Vertical stacked bar graph depicting the number of elective and emergency surgeries performed between 25th March and 31st May, in 2019 and 2020. The total number of surgeries at our department decreased by 52.2% as compared to last year. The proportion of non-emergent cases decreased from 57.7% in 2019 to 11.3% in 2020. This change was found to be statistically significant (p value = 0.000).

Fig. 2

Horizontal stacked bar graph depicting the number of elective and emergency surgeries performed in each phase of lockdown. 28 (52.8%) surgeries were performed during Phase I, 20 (37.7%) during Phase II, 2 (3.7%) during Phase III and 3 (5.6%) during Phase IV. No elective cases were done during lockdown III and IV.

Fig. 3

Frequency polygon depicting the number of surgeries performed in relation to the rising trend of COVID-19 cases in Uttarakhand from March 25th to May 31st 2020. The number of surgeries performed decreased as the number of COVID-19 cases rose (p value = 0.000, correlation coefficient = −0.914).

Fig. 4

Clustered bar graph depicting the speciality-wise distribution of surgeries performed between March 25th to May 31st in 2019 and 2020. A reduction in all specialities is observed. No surgeries for congenital conditions and degenerative spinal conditions were performed during the period of the lockdown.