Impact of COVID-19 on a Neurosurgical Service: Lessons from the University of California San Diego

Abstract

Background: The institution-wide response of the University of California San Diego Health system to the 2019 novel coronavirus disease (COVID-19) pandemic was founded on rapid development of in-house testing capacity, optimization of personal protective equipment usage, expansion of intensive care unit capacity, development of analytic dashboards for monitoring of institutional status, and implementation of an operating room (OR) triage plan that postponed nonessential/elective procedures. We analyzed the impact of this triage plan on the only academic neurosurgery center in San Diego County, California, USA.

Methods: We conducted a de-identified retrospective review of all operative cases and procedures performed by the Department of Neurosurgery from November 24, 2019, through July 6, 2020, a 226-day period. Statistical analysis involved 2-sample z tests assessing daily case totals over the 113-day periods before and after implementation of the OR triage plan on March 16, 2020.

Results: The neurosurgical service performed 1429 surgical and interventional radiologic procedures over the study period. There was no statistically significant difference in mean number of daily total cases in the pre-versus post-OR triage plan periods (6.9 vs. 5.8 mean daily cases; 1-tail P = 0.050, 2-tail P = 0.101), a trend reflected by nearly every category of neurosurgical cases.

Conclusions: During the COVID-19 pandemic, the University of California San Diego Department of Neurosurgery maintained an operative volume that was only modestly diminished and continued to meet the essential neurosurgical needs of a large population. Lessons from our experience can guide other departments as they triage neurosurgical cases to meet community needs.

Keywords: COVID-19; Elective; Essential; Operative volume.

Figure 1

2019 Novel coronavirus disease (COVID-19) statistics in San Diego County, California, USA, across the total study period, obtained from the county-wide daily dashboard established and maintained by the Epidemiology and Immunization Services Branch of the San Diego County Health and Human Services Agency. (A) Daily new COVID-19 cases in San Diego County. (B) Running total number of confirmed COVID-19 cases in San Diego County. (C) Daily COVID-19 deaths and rolling average of percentage positive COVID-19 cases in San Diego County. (D) Running total number of COVID-19–related hospitalizations, intensive care unit admissions, and deaths in San Diego County. (E) Estimates of effective reproductive number of COVID-19 in San Diego County by various institutions, as compiled by the California Department of Public Health. ICU, intensive care unit; UCLA, University of California Los Angeles; LEMMA, Local Epidemic Modeling for Management & Action; JHU, Johns Hopkins University; UCSF, University of California San Francisco.[CN1] (A–D, Data from the public County of San Diego Coronavirus Disease 2019 [COVID-19] Dashboard, maintained by the Epidemiology and Immunization Services Branch of the San Diego County Health and Human Services Agency. E, Data from the public open-source California COVID Assessment Tool, maintained by the California Department of Public Health.)

Figure 2

2019 Novel coronavirus disease (COVID-19) statistics at University of California San Diego Health, including inpatient census, ventilator status, and testing statistics among staff and students, obtained from the daily dashboard that was implemented as a part of the institution-wide response to the COVID-19 pandemic. (A) COVID-19 inpatient census and ventilator status at University of California San Diego Health during the study period. (B) COVID-19 testing statistics, including 7-day rolling average percentage of positive tests, among University of San Diego Health employees and students during the study period. UCSD, University of San Diego.

Figure 3

Breakdown of University of California San Diego neurosurgical operative cases and procedures by type across the total study period and pre–and post–operating room (OR) triage plan implementation. (A) Case breakdown over the total 226-day period of the retrospective study. (B) Case breakdown over the 113 days before implementation of the University of California San Diego 2019 novel coronavirus disease (COVID-19) OR triage plan on March 16, 2020. (C) Case breakdown over the 113 days after implementation of the OR triage plan. VPS, ventriculoperitoneal shunt; LP, lumboperitoneal (shunt); IR, interventional radiology; ESI, epidural steroid injection; EEA, endoscopic endonasal approach.

Figure 4

Rolling 30-day averages of daily University of California San Diego neurosurgical operative cases and procedures, total and by type, over the total 226-day period of the study. Implementation of the 2019 novel coronavirus disease (COVID-19) operating room triage plan on March 16, 2020, is delineated in red. EEA, endoscopic endonasal approach; VPS, ventriculoperitoneal shunt; LP, lumboperitoneal (shunt); IR, interventional radiology; ESI, epidural steroid injection.