Neurosurgical Procedures and Safety During the COVID-19 Pandemic: A Case-Control Multi-Center Study

Bajunaid, Khalid; Alqurashi, Ashwag; Alatar, Abdullah; Alkutbi, Mohammad; Alzahrani, Anas H.; Sabbagh, Abdulrahman J.; Alobaid, Abdullah; Barnawi, Abdulwahed; Alferayan, Ahmed Abdulrahman; Alkhani, Ahmed M.; Salamah, Ali Bin; Sheikh, Bassem Yousef; Alotaibi, Fahad E.; Alabbas, Faisal; Farrash, Faisal; Al-Jehani, Hosam M.; Alhabib, Husam; Alnaami, Ibrahim; Altweijri, Ikhlass; Khoja, Isam; Taha, Mahmoud; Alzahrani, Moajeb; Bafaquh, Mohammed S.; Binmahfoodh, Mohammed; Algahtany, Mubarak Ali; Al-Rashed, Sabah; Raza, Syed Muhammad; Elwatidy, Sherif; Alomar, Soha A.; Al-Issawi, Wisam; Khormi, Yahya H.; Ammar, Ahmad; Al-Habib, Amro; Baeesa, Saleh S.; Ajlan, Abdulrazag

Abstract: Objective Quantitative documentation of the effects of outbreaks, including the COVID-19 pandemic, is limited in the field of neurosurgery. Our study aimed to evaluate the effects of the COVID-19 pandemic on neurosurgical practice and to determine whether surgical procedures are associated with increased morbidity and mortality. Methods A multicenter case-control study was conducted, involving patients who underwent neurosurgical intervention in the Kingdom of Saudi Arabia during two periods: pre-COVID-19, and during the COVID-19 pandemic. The surgical intervention data evaluated included diagnostic category, case priority, complications, length of hospital stay, and 30-day mortality. Results A total of 850 procedures were included, 36% during COVID-19. The median number of procedures per day was significantly lower during the COVID-19 period (5.5 cases) than the pre-COVID-19 period (12 cases, P-value<0.0001). Complications, length of hospital stay, and 30-day mortality rates did not differ during the pandemic. In a multivariate analysis comparing both periods, case priority levels 1 (immediate) (OR 1.82, 95%CI 1.24–2.67), 1 (1–24 h) (OR 1.63, 95%CI 1.10–2.41), and 4 (OR 0.28, 95%CI 0.19–0.42) showed significant differences. Conclusions During the early phase of the COVID-19 pandemic, the overall number of neurosurgical procedures declined, but the load of emergency procedures remained the same, thus highlighting the need to allocate sufficient resources for emergencies. More importantly, performing neurosurgical procedures during the pandemic in regions with limited effects of the outbreak on the health care system was safe. Our findings may aid in developing guidelines for acute and long-term care during pandemics in surgical sub-specialties.