Demand for essential non-ambulatory neurosurgical care decreased while acuity of care increased during the COVID surge.

Shao, Belinda; Tang, Oliver Y; Leary, Owen P; Abdulrazeq, Hael; Sastry, Rahul A; Brown, Sarah; Wilson, Ira B; Asaad, Wael F; Gokaslan, Ziya L

BACKGROUND In times of health resource reallocation, capacities must remain able to meet a continued demand for essential, non-ambulatory neurosurgical acute care. This study sought to characterize the demand for and provision of neurosurgical acute care during the COVID-19 pandemic. METHODS This single-center cross-sectional observational analysis compared nonambulatory neurosurgical consult encounters during the peri-surge period (3/9-5/31/2020) with those during an analogous period in 2019. Outcomes included consult volume, distribution of problem types, disease severity, and rate of acute operative intervention. RESULTS A total of 1,494 neurosurgical consults were analyzed. Amidst the pandemic surge, 583 consults were seen, which was 6.4 standard deviations below the mean among analogous 2016-2019 periods (mean=873; SD=45, p=0.001). Between 2019 and 2020, the proportion of degenerative spine consults decreased in favor of spinal trauma (25.6% vs 34% and 51.9% vs 41.4%, p=0.088). Among aneurysmal subarachnoid hemorrhage cases, poor-grade (HH4-5) presentations were more common (30% vs 14.8%, p=0.086). A higher proportion of pandemic era consults resulted in acute operative management, with an unchanged absolute frequency of acutely operative consults (123/583 (21.1%) vs 120/911 (13.2%), p<0.001). CONCLUSIONS Neurosurgical consult volume during the pandemic surge hit a 5-year institutional low. Amidst vast reallocation of healthcare resources, demand for high-acuity non-ambulatory neurosurgical care continued, and proportionally increased for higher-acuity pathologies. In our continued current pandemic as well as any future situations of mass health resource reallocation, neurosurgical acute care capacities must be preserved.