COVID-19 impact on neurosurgical practice: lockdown attitude and experience of a European academic center.

LUBANSU, Alphonse; ASSAMADI, Mouhssine; BARRIT, Sami; DEMBOUR, Victoria; YAO, Gedeon; HADWE, Salim EL.; WITTE, Olivier DE.

Introduction The Coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge. Different models of reorganization have been described aiming to preserve resources while ensuring optimal medical care. limited clinical neurosurgical experience including COVID-19 patients have been reported. We share organizational experience, attitudes, and preliminary data of patients treated at our institution. Methods Institutional guidelines and patient workflow are described and visualized. A cohort of all neurosurgical patients managed during the lockdown period is presented and analyzed assessing suspected nosocomial infection risk factors. A comparative surgical subcohort from the previous year was used to investigate the impact on surgical activity. Results A total of 176 patients were admitted in 66 days, twenty tested positive for COVID-19. Patients initially admitted to the neurosurgical ward were less likely to be suspected for a COVID-19 infection when compared to patients admitted for critical emergencies, particularly with neurovascular and stroke-related pathologies. The mortality rate of COVID-19 patients was remarkably high (45%), and even higher in patients that underwent surgical intervention (77 %). In addition to the expected drop in surgical activity (-53%), a decrease in traumatic emergencies was noted. Conclusion By applying infection prevention and resource-sparing logistics measures shared by the international medical community, we were able to maintain essential neurosurgical care in a pandemic with controlled nosocomial infection risk. Special consideration should be given to medical management and surgical indications in patients infected with the SARS-CoV-2 virus, as they seem to exhibit a problematic hemostatic profile that might result in an unfavorable clinical and surgical outcome.