Neurosurgical referral patterns during the COVID-19 pandemic: A United Kingdom experience

Jayakumar, Nithish; Kennion, Oliver; Villabona, Alvaro Rojas; Paranathala, Menaka; Holliman, Damian

Background COVID-19 is a severe respiratory viral illness that has spread rapidly across the world, but the United Kingdom has been particularly affected. Evidence suggests that stroke, cardiac, and spinal presentations fell during the pandemic as the public avoided seeking care. The impact on neurosurgical presentations and referrals during COVID-19 is unclear. Our aim, therefore, was to describe the referral patterns to a high-volume neurosurgical department in the United Kingdom during the COVID-19 pandemic. Methods Electronic referrals were identified from the referrals database for the period between 01/01/2020 and 31/05/2020, inclusive, with the month of January used as a baseline. Demographics and referral diagnoses were captured on Excel (Microsoft). Statistical analyses were performed on SPSS v22 (IBM). Differences between referral volumes were evaluated by chi-square goodness-of-fit tests. Results A total of 2293 electronic referrals were received during the study period. Median age was 63 years. Overall, referrals fell significantly in volume during the study period (χ2(4)=60.95; p<0.001). Patterns in daily referrals as the pandemic progressed are described. There was a statistically significant reduction in the volume of referrals for degenerative spine cases and traumatic brain injuries (p<0.001). Conclusions Referrals for degenerative spine and traumatic brain injuries fell significantly during the pandemic which can be explained by the lower vehicular traffic and patient avoidance of healthcare services, respectively. The risk of neurological deterioration and increased morbidity and mortality, as a consequence, is of concern and neurosurgeons worldwide need to consider optimal strategies to mitigate these risks as the pandemic eases.