Surgical Prioritization: The Northwell Neurosurgical Prioritization Initiative

Thomas, Justin G; Gandhi, Shashank V; White, Timothy G; Jocelyn, Christian; Soo, Teck M; Eisenberg, Mark B; Schulder, Michael; Narayan, Raj K

INTRODUCTION: Beginning in March, 2020, hospitals across the majority of the United States were required to cancel all elective surgery in preparation for a surge of patients with the coronavirus disease of 2019 (COVID-19). A large number of neurosurgical patients with less than emergency conditions had their surgery postponed indefinitely. METHODS: The Delphi method was used to obtain consensus. Twenty-two neurosurgeons actively practicing in two separate geographic regions of the United States where “black level” COVID-19 surges occurred (New York Metropolitan Area and Detroit, Michigan) participated. A total of 86 neurosurgical case scenarios were categorized into six tiers of priority: emergent or within 24 hours, within 48 hours, within 1 week, within 2 weeks, within one month, or post hospital crisis/more than 4 weeks. Consensus was defined as 75% of participants reaching an agreement. Majority opinion (>50% agreement) was also reported. RESULTS: 67 of the 86 surgical scenarios (78%) reached a consensus agreement with 85 out of 86 scenarios reaching at least a majority opinion. Only one scenario (central cord syndrome) did not reach any agreement. CONCLUSION: The NNPI developed in this study can assist neurosurgical departments in prioritizing the timing of surgery, whether it be due to a pandemic, or any other scenario where the normal work flow has been severely disrupted and resources are limited.