Patients awaiting surgery for neurosurgical diseases during the first wave of the COVID-19 pandemic in Spain: a multicentre cohort study

Abstract

Objectives: The large number of infected patients requiring mechanical ventilation has led to the postponement of scheduled neurosurgical procedures during the first wave of the COVID-19 pandemic. The aims of this study were to investigate the factors that influence the decision to postpone scheduled neurosurgical procedures and to evaluate the effect of the restriction in scheduled surgery adopted to deal with the first outbreak of the COVID-19 pandemic in Spain on the outcome of patients awaiting surgery.

Design: This was an observational retrospective study.

Settings: A tertiary-level multicentre study of neurosurgery activity between 1 March and 30 June 2020.

Participants: A total of 680 patients awaiting any scheduled neurosurgical procedure were enrolled. 470 patients (69.1%) were awaiting surgery because of spine degenerative disease, 86 patients (12.6%) due to functional disorders, 58 patients (8.5%) due to brain or spine tumours, 25 patients (3.7%) due to cerebrospinal fluid (CSF) disorders and 17 patients (2.5%) due to cerebrovascular disease.

Primary and secondary outcome measures: The primary outcome was mortality due to any reason and any deterioration of the specific neurosurgical condition. Second, we analysed the rate of confirmed SARS-CoV-2 infection.

Results: More than one-quarter of patients experienced clinical or radiological deterioration. The rate of worsening was higher among patients with functional (39.5%) or CSF disorders (40%). Two patients died (0.4%) during the waiting period, both because of a concurrent disease. We performed a multivariate logistic regression analysis to determine independent covariates associated with maintaining the surgical indication. We found that community SARS-CoV-2 incidence (OR=1.011, p<0.001), degenerative spine (OR=0.296, p=0.027) and expedited indications (OR=6.095, p<0.001) were independent factors for being operated on during the pandemic.

Conclusions: Patients awaiting neurosurgery experienced significant collateral damage even when they were considered for scheduled procedures.

Keywords: Adult surgery; COVID-19; NEUROSURGERY; Neurosurgery; PUBLIC HEALTH; Paediatric neurosurgery.

Figure 1

Patient subgroups according to their condition of being operated or not operated during the study period. Created by the authors.

Figure 2

Bar plot of the number of new inclusions (blue), cumulative number of patients in the surgical list (grey) and number of operated patients (orange) per epidemiological week and their association with community SARS-CoV-2 incidence. Created by the authors.

Figure 3

Bar plot of the median number of total number of patients who were waiting for a scheduled procedure at the end of 2019 and 2020 and the median waiting time for degenerative spine disease for the same periods. (A) Data for each collaborative centre, (B) data for each province, (C) data according to COVID-19 burden (percentage of hospital beds occupied by patients with COVID-19). Created by the authors.