Neurosurgical outcomes, protocols and resource management during lockdown: An early institutional experience from one of world’s largest COVID 19 hotspots

Sudhan, Manoharan Dwark; Singh, Rupesh Kumar; Yadav, Rahul; Sivasankar, Rajeev; Mathai, Sheila Samanta; Shankaran, Ramakrishnan; Kulkarni, Sachin Narayan; Shanthanu, Cherukuri Prakash; Sandhya, Lingappa Moolya; Shaikh, Azimuddin

Background As the COVID-19 pandemic completes one year, it is prudent to reflect back upon the challenges faced and the management strategies employed to tackle this overwhelming healthcare crisis. We undertook this study to validate our institutional protocols which were formulated to cater to the change in volume and pattern of neurosurgical cases during the raging pandemic. Methods All admitted patients scheduled to undergo major neurosurgical intervention during the lockdown period (15 March 2020 to 15 September 2020) were included in the study. The data involving surgery outcomes, disease pattern, anaesthesia techniques, patient demographics as well as COVID-19 status was analysed and compared with similar retrospective data of neurosurgical patients operated during the same time period in the previous year (15 March 2019 to 15 September 2019). Results Barring significant increase in surgery for stroke (P = 0.008) and hydrocephalus (P <0.001), the overall case load of neurosurgery during the study period in 2020 was 42.75% of that in 2019 (P <0.001); and the same was attributable to a significant reduction in elective spine surgeries (P < 0.001). However no significant difference was observed in the overall incidence of emergency and essential surgeries undertaken during the two time periods (P = 0.482). There was an increased incidence in the use of monitored anaesthesia care (MAC) techniques during emergency and essential neurosurgical procedures by the anaesthesia team in 2020 (P < 0.001). COVID-19 patients had overall poor outcomes (P = 0.003), with significant increase in mortality amongst those subjected to general anaesthesia vis-a-vis MAC (p = 0.014). Conclusions Despite a significant decrease in neurosurgical workload during the COVID-19 lockdown period in 2020, the volume of emergency and essential surgeries did not change much compared to the previous year. Surgery in COVID-19 patients is best avoided, unless critical, as the outcome in these patients is not favourable. The employment of monitored anaesthesia care techniques like awake craniotomy, and regional anaesthesia; facilitate a better outcome in the COVID-19 era.