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. 2021 Feb;163(2):317-329.
doi: 10.1007/s00701-020-04652-8. Epub 2020 Nov 21.

Neurosurgery and coronavirus: impact and challenges-lessons learnt from the first wave of a global pandemic

Keyoumars Ashkan  1   2 , Josephine Jung  3   4 , Alexandra Maria Velicu  1   2 , Ahmed Raslan  1 , Mohammed Faruque  1 , Pandurang Kulkarni  1 , Cristina Bleil  1 , Harutomo Hasegawa  1 , Ahilan Kailaya-Vasan  1 , Eleni Maratos  1 , Gordan Grahovac  1 , Francesco Vergani  1 , Bassel Zebian  1 , Sinan Barazi  1 , Irfan Malik  1 , David Bell  1 , Daniel Walsh  1 , Ranjeev Bhangoo  1 , Christos Tolias  1 , Sanjeev Bassi  1 , Richard Selway  1 , Nick Thomas  1 , Christopher Chandler  1 , Richard Gullan  1
Affiliations

Neurosurgery and coronavirus: impact and challenges-lessons learnt from the first wave of a global pandemic

Keyoumars Ashkan et al. Acta Neurochir (Wien). 2021 Feb.

Abstract

Introduction and objectives: The novel severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has had drastic effects on global healthcare with the UK amongst the countries most severely impacted. The aim of this study was to examine how COVID-19 challenged the neurosurgical delivery of care in a busy tertiary unit serving a socio-economically diverse population.

Methods: A prospective single-centre cohort study including all patients referred to the acute neurosurgical service or the subspecialty multidisciplinary teams (MDT) as well as all emergency and elective admissions during COVID-19 (18th March 2020-15th May 2020) compared to pre-COVID-19 (18th of January 2020-17th March 2020). Data on demographics, diagnosis, operation, and treatment recommendation/outcome were collected and analysed.

Results: Overall, there was a reduction in neurosurgical emergency referrals by 33.6% and operations by 55.6% during the course of COVID-19. There was a significant increase in the proportion of emergency operations performed during COVID-19 (75.2% of total, n=155) when compared to pre-COVID-19 (n = 198, 43.7% of total, p < 0.00001). In contrast to other published series, the 30-day perioperative mortality remained low (2.0%) with the majority of post-operative COVID-19-infected patients (n = 13) having underlying medical co-morbidities and/or suffering from post-operative complications.

Conclusion: The capacity to safely treat patients requiring urgent or emergency neurosurgical care was maintained at all times. Strategies adopted to enable this included proactively approaching the referrers to maintain lines of communications, incorporating modern technology to run clinics and MDTs, restructuring patient pathways/facilities, and initiating the delivery of NHS care within private sector hospitals. Through this multi-modal approach we were able to minimize service disruptions, the complications, and mortality.

Keywords: Coronavirus; Emergency referrals; Neurosurgery; Pandemic.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
This graph describes the number of patients admitted to our hospital with COVID-19 infection. Overall number of inpatients is depicted in black, and the number of patients in intensive care is provided in grey. Day 0 was the 04th of March 2020
Fig. 2
Fig. 2
Flowchart describing admission pathway for patients requiring urgent treatment during COVID-19. All neurosurgical patients were swabbed for COVID-19 upon arrival at KCH. If urgent surgery was required, they were taken to theatre and treated as COVID-19 positive until the test result was available. If urgent surgery was not required, they were isolated in a side room in a dedicated holding ward until the COVID-19 test result was available and then either cared for in a COVID-19-positive ward or allocated to a COVID-19-negative ward based on the results
See this image and copyright information in PMC

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