The impact of reduced operating room capacity on the time delay of urgent surgical care for neurosurgical patients during the COVID-19 pandemic

Abstract

Background: The COVID-19 pandemic raised major challenges to the management of patient flows and medical staff resource allocation. To prevent the collapse of medical facilities, elective diagnostic and surgical procedures were drastically reduced, canceled or rescheduled.

Methods: We recorded all in-hospital treated patients and outpatient clinics visits of our neurosurgical department from March 2017 to February 2021. Changes of OR capacity, in-hospital neurosurgical treatments and outpatient clinics visits during the pandemic episode was compared on a monthly bases to the previous years.

Results: A total of 3'214 data points from in-house treated patients and 11'400 outpatient clinics visits were collected. The ratio of elective (73.5% ± 1.5) to emergency surgeries (26.5% ± 1.5) remained unchanged from 2017 to 2021. Significantly less neurosurgical interventions were performed in April 2020 (-42%), significantly more in July 2020 (+36%). Number of outpatient clinics visits remained in the expected monthly range (mean n = 211 ± 67). Total OR capacity was reduced to 30% in April 2020 and 55% in January 2021. No significant delay of urgent surgical treatments was detected during restricted (<85%) OR capacity. On average, the delay of rescheduled consultations was 58 days (range 3 - 183 days), three (6.5%) were referred as emergencies.

Conclusions: Dynamic monitoring and adjustment of resources is essential to maintain surgical care. The sharp restrictions of surgical activities resulted in significant fluctuations and 5% decrease of treated neurosurgical patients during the COVID-19 pandemic. However, urgent neurosurgical care was assured without significant time delay during periods of reduced OR capacity.

Keywords: FOPH, federal office of public health; HRA, Human Research Act; Hospital outpatient clinics; ICU, Intensive Care Unit; Neurosurgery; Non-COVID-19 patients; OR, operating room; Operating room capacity; Pandemic care management.

Fig. 1

7-day moving average of daily new COVID-19 infections in Switzerland from March 2020 to February 2021 showing the first (peak n = 1065 end of March 2020) and second wave (peak n = 8029 begin of November 2020).

Fig. 2

Outpatient clinics visits on a monthly basis from 2017 to 2021 - no significant outlier month (±2σ, mean n = 211, σ ± 67) was detected during the COVID-19 pandemic episode.

Fig. 3

OR capacity during COVID-19 with capacity reduction in April 2020 (all-time low of 30%) and in January 2021 (55%). Normal OR capacity utilization remained above 85% from mid Mai to mid December 2020.

Fig. 4

Treated neurosurgical patients at our institution from 2017 to 2021 (mean n = 67, σ ± 11). Significantly less patients were treated in April (n = 39), significantly more in July 2021 (n = 91).

Fig. 5

During reduced OR capacity (<85%), neither in brain tumor (p = 0.928) nor spine trauma (p = 0.069) patients a significant delay from initial diagnosis to urgent operative treatment was detected (excluded patients / outliers n = 13).