Tracking the Volume of Neurosurgical Care during the COVID-19 Pandemic

Patel, Pious D.; Kelly, Katherine A.; Reynolds, Rebecca A.; Turer, Robert W.; Salwi, Sanjana; Rosenbloom, S. Trent; Bonfield, Christopher M.; Naftel, Robert P.

Abstract Objective This study quantifies the impact of COVID-19 on the volume of adult and pediatric neurosurgical procedures, inpatient consults, and clinic visits at an academic medical center. Methods Neurosurgical procedures, inpatient consults, and outpatient appointments at Vanderbilt University Medical Center were identified in the time periods of March 23, 2020 through May 8, 2020 ("During COVID-19") and March 25, 2019 through May 10, 2019 ("Before COVID-19"). Neurosurgical volume was compared between these periods. Results A 40% reduction in weekly procedural volume was demonstrated during COVID-19 (median 75 [IQR 72-80] to 45 [43-47], p<0.001). There was a 42% reduction for weekly adult procedures (62 [54-70] to 36 [34-39], p<0.001), and 31% reduction for weekly pediatric procedures (13 [12-14] to 9 [8-10], p=0.004). Among adult procedures, the most significant decreases were seen for spine (p<0.001), endovascular (p<0.001), and cranioplasty (p<0.001). There was not a significant change for adult open vascular (p=0.291), functional (p=0.263), cranial tumor (p=0.143), or hydrocephalus (p=0.173) procedural volume. Weekly inpatient consults to neurosurgery decreased by 24% (99 [94-114] to 75 [68-84], p=0.008) for adults. Weekly in-person adult and pediatric outpatient clinic visits witnessed a 91% decrease (329 [326-374] to 29 [26-39], p<0.001). Weekly telehealth encounters increased from 0 [0-0] to 151 [126-156] (p<0.001). Conclusion There were significant reductions in neurosurgical operations, clinic visits, and inpatient consults during COVID-19. Telehealth was increasingly used for assessment. The long-term impacts of reduced neurosurgical volume and increased telehealth utilization on patient outcomes should be explored.