Elsevier

World Neurosurgery

Volume 142, October 2020, Pages e183-e194
World Neurosurgery

Original Article
Tracking the Volume of Neurosurgical Care During the Coronavirus Disease 2019 Pandemic

https://doi.org/10.1016/j.wneu.2020.06.176Get rights and content

Objective

In the present study, we quantified the effect of the coronavirus disease 2019 (COVID-19) on the volume of adult and pediatric neurosurgical procedures, inpatient consultations, and clinic visits at an academic medical center.

Methods

Neurosurgical procedures, inpatient consultations, and outpatient appointments at Vanderbilt University Medical Center were identified from March 23, 2020 through May 8, 2020 (during COVID-19) and March 25, 2019 through May 10, 2019 (before COVID-19). The neurosurgical volume was compared between the 2 periods.

Results

A 40% reduction in weekly procedural volume was demonstrated during COVID-19 (median before, 75; interquartile range [IQR], 72–80; median during, 45; IQR, 43–47; P < 0.001). A 42% reduction occurred in weekly adult procedures (median before, 62; IQR, 54–70; median during, 36; IQR, 34–39; P < 0.001), and a 31% reduction occurred in weekly pediatric procedures (median before, 13; IQR, 12–14; median during, 9; IQR, 8–10; P = 0.004). Among adult procedures, the most significant decreases were seen for spine (P < 0.001) and endovascular (P < 0.001) procedures and cranioplasty (P < 0.001). A significant change was not found in the adult open vascular (P = 0.291), functional (P = 0.263), cranial tumor (P = 0.143), or hydrocephalus (P = 0.173) procedural volume. Weekly inpatient consultations to neurosurgery decreased by 24% (median before, 99; IQR, 94–114; median during, 75; IQR, 68–84; P = 0.008) for adults. Weekly in-person adult and pediatric outpatient clinic visits witnessed a 91% decrease (median before, 329; IQR, 326–374; median during, 29; IQR, 26–39; P < 0.001). In contrast, weekly telehealth encounters increased from a median of 0 (IQR, 0–0) before to a median of 151 (IQR, 126–156) during COVID-19 (P < 0.001).

Conclusions

Significant reductions occurred in neurosurgical operations, clinic visits, and inpatient consultations during COVID-19. Telehealth was increasingly used for assessments. The long-term effects of the reduced neurosurgical volume and increased telehealth usage on patient outcomes should be explored.

Key words

COVID-19
Elective surgery
Neurological surgery
SARS-CoV-2
Telehealth
Trauma

Abbreviations and Acronyms

ACS
American College of Surgeons
COVID-19
Coronavirus disease 2019
CPT
Current Procedural Terminology
ED
Emergency department
IQR
Interquartile range
VUMC
Vanderbilt University Medical Center

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Conflict of interest statement: Dr. Reynolds serves as a Fogarty Global Health Trainee affiliated with the Vanderbilt-Emory-Cornell-Duke consortium and is supported by the Fogarty International Center at the National Institutes of Health (grant R25TW009337). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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