The impact of COVID-19 pandemic on neurosurgical practice and feasibility of safe resumption of elective procedures during this era in a large referral center in Tehran, Iran: An unmatched case-control study

Tavanaei, Roozbeh; Ahmadi, Pooria; Yazdani, Kaveh Oraii; Zali, Alireza; Oraee-Yazdani, Saeed

Objective The COVID-19 pandemic has considerably impacted surgical practice. The present study aimed to investigate the effects of the pandemic on neurosurgical practice and the safety of the resumption of elective procedures through implementing screening protocols in a high-volume academic public center in Iran as one of the countries severely affected by the pandemic. Methods This unmatched case-control study compared two populations of patients who underwent neurosurgical procedures between June 1, 2019- September 1, 2019, and the same period in 2020. In the prospective part of the study, patients who underwent elective procedures were tested for SARS-CoV-2 infection postoperatively to evaluate the viability of our screening protocol. Results Elective and emergency procedures showed significant reduction (59.4%, n=168 vs 71.3%, n=380) and increase (28.7%, n=153 vs 40.6%, n=115) in their percentages during the pandemic period, respectively (p=0.003). The proportional distribution of neurosurgical categories remained unchanged during the pandemic period. Poisson regression showed that the reduction in total daily admissions and some categories, including spine, trauma, oncology, and infection were significantly correlated with the pandemic period. Among patients who underwent elective procedures, 0 (0.0%) and 26 (16.25%) had positive test results on day-30 and 60 postoperatively, respectively. Overall mortality rates were comparable between the pre-COVID-19 and COVID-19 periods, yet patients with concurrent SARS-CoV-2 infection showed substantially higher mortality rates (65%). Conclusion By implementing safety and screening protocols with proper resource allocation, we can maintain the emergency care capacity while minimizing the risk of hospital-acquired SARS-CoV-2 infection, complications, and mortality among neurosurgical patients during the pandemic period. Similarly, for elective procedures, according to available resources, we can allocate hospital beds for patients with a higher risk of delayed hospitalization and reassure those who are concerned about the risk of hospital-acquired infection.