Demands for Essential Neurosurgical Care During the COVID-19 Pandemic

INTRODUCTION: The COVID-19 pandemic has caused unprecedented social, geopolitical, and health systems factors that may affect types of patients presenting for essential, non-ambulatory care. Social distancing and lockdowns may reduce the incidence of trauma; however, a significant decline in presentations of acute medical conditions such as stroke and ACS have been reported. Furthermore, health system capacities are substantially altered, with elective surgeries postponed to devote resources to COVID-related illness and high acuity non-COVID illness. METHODS: We reviewed all emergency department and inpatient consultations to the neurosurgical service at a Level 1 Trauma Center during an 8-week post-lockdown period (3/15-5/4), quantifying overall volume, as well the distribution of problem types and management endpoints. RESULTS: Pandemic period consult volumes were significantly lower than those of parallel periods in 2016–2019 (388 vs. a 4-year average of 576, P < .001, Pearson's chi-squared test). Compared to 2016–2019, 2020 consult volume was decreased by 37% during the first four weeks following lockdown (204 vs. 280, P = .01), and by 48% during the latter four weeks (184 vs. 296, P < .001). Pandemic period consults required acute surgery in 21% of cases, non-acute or non-surgical management in 75%, and palliative management (CMO, hospice, death) in 4%. During the prior year (2019), these proportions were 15%, 80% and 5%, respectively (P = .06). The distribution of consult problem types was not statistically different between periods. Among cranial consults, trauma comprised 45% during the pandemic compared to 41% in the analogous 2019 period; tumor 20% vs 18%; vascular 16%; and ICH/stroke 8%. Among spinal consults, trauma comprised 47% vs 43%, tumor 6% vs 3%, and degenerative disc disease 29% vs 36%. CONCLUSION: Neurosurgical consult volume increasingly declined throughout the post-lockdown COVID-19 pandemic period, which was unprecedented over the 5 years studied. A higher proportion of consults resulted in acute care surgery, approaching statistical significance. Surprisingly, problem types did not differ in the pandemic period despite vastly different social circumstances. Further study will employ time series analysis to contextualize these changes within local COVID-19 surge data.