Neurosurgery subspecialty practice during a pandemic: a multicenter analysis of operative practice in 7 U.S. neurosurgery departments during COVID-19

Authors

Dimitri Benner, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Benjamin K. Hendricks, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Cyrus Elahi, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Michael D. White, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Gary Kocharian, Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York.
Leonardo E. Albertini Sanchez, Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York.
Kyle E. Zappi, Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York.
Andrew L. Garton, Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York.
Joseph A. Carnevale, Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York.
Theodore H. Schwartz, Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York.
Ehsan Dowlati, Department of Neurosurgery, Georgetown University, Washington, DC.
Daniel R. Felbaum, Department of Neurosurgery, Georgetown University, Washington, DC.
Kenneth D. Sack, Department of Neurosurgery, The George Washington University, Washington, DC.
Walter C. Jean, Department of Neurosurgery, The George Washington University, Washington, DC.
Andrew K. Chan, Department of Neurosurgery, University of California, San Francisco, San Francisco, California.
John F. Burke, Department of Neurosurgery, University of California, San Francisco, San Francisco, California.
Praveen V. Mummaneni, Department of Neurosurgery, University of California, San Francisco, San Francisco, California.
Michael J. Strong, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
Timothy J. Yee, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
Mark E. Oppenlander, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
Mariam Ishaque, Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
Mark E. Shaffrey, Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
Hasan R. Syed, Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.

Document Type

Journal Article

Publication Date

6-17-2022

Journal

World neurosurgery

DOI

10.1016/j.wneu.2022.06.010

Keywords

COVID-19; acuity; epidemiology; multicenter; neurosurgical subspecialty practice; pandemic

Abstract

OBJECTIVE: Changes to neurosurgical practices during the COVID-19 pandemic have not been thoroughly analyzed. We report the effects of operative restrictions imposed under variable local COVID-19 infection rates and healthcare policies using a retrospective multi-center cohort study and highlight shifts in operative volumes and subspecialty practice. METHODS: Seven academic neurosurgery departments' neurosurgical case logs were collected; procedures in April 2020 (COVID-19 surge) and April 2019 (historical control) were analyzed overall and by 6 subspecialties. Patient acuity, surgical scheduling policies, and local surge levels were assessed. RESULTS: Operative volume during COVID-19 decreased 58.5% from the previous year (602 vs 1449, p=0.001). COVID-19 infection rates within departments' counties correlated with decreased operative volume (r=0.695, p=0.04) and increased patient categorical acuity (p=0.001). Spine procedure volume decreased by 63.9% (220 vs 609, p=0.002), for a significantly smaller proportion of overall practice during the COVID-19 surge (36.5%) versus the control period (42.0%) (p=0.02). Vascular volume decreased by 39.5% (72 vs 119, p=0.01) but increased as a percentage of caseload (8.2% in 2019 vs 12.0% in 2020, p=0.04). Neuro-oncology procedure volume decreased by 45.5% (174 vs 318, p=0.04) but maintained a consistent proportion of all neurosurgeries (28.9% in 2020 vs 21.9% in 2019, p=0.09). Functional neurosurgery volume, which declined by 81.4% (41 vs 220, p=0.008), represented only 6.8% of cases during the pandemic versus 15.2% in 2019 (p=0.02). CONCLUSIONS: Operative restrictions during COVID-19 led to distinct shifts in neurosurgical practice, and local infective burden played a significant role in operative volume and patient acuity.

APA Citation

Benner, Dimitri; Hendricks, Benjamin K.; Elahi, Cyrus; White, Michael D.; Kocharian, Gary; Albertini Sanchez, Leonardo E.; Zappi, Kyle E.; Garton, Andrew L.; Carnevale, Joseph A.; Schwartz, Theodore H.; Dowlati, Ehsan; Felbaum, Daniel R.; Sack, Kenneth D.; Jean, Walter C.; Chan, Andrew K.; Burke, John F.; Mummaneni, Praveen V.; Strong, Michael J.; Yee, Timothy J.; Oppenlander, Mark E.; Ishaque, Mariam; Shaffrey, Mark E.; Syed, Hasan R.; and Lawton, Michael T., "Neurosurgery subspecialty practice during a pandemic: a multicenter analysis of operative practice in 7 U.S. neurosurgery departments during COVID-19" (2022). GW Authored Works. Paper 1097.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1097

Department

Neurological Surgery