Neurosurgical practice during the SARS-CoV-2 pandemic: a worldwide survey

Fontanella, Marco M.; De Maria, Lucio; Zanin, Luca; Saraceno, Giorgio; Terzi di Bergamo, Lodovico; Servadei, Franco; Chaurasia, Bipin; Olivi, Alessandro; Vajkoczy, Peter; Schaller, Karl; Cappabianca, Paolo; Doglietto, Francesco

Abstract Background and Objective The SARS-CoV-2 pandemic has consistently changed medical practice throughout specialties, regardless of their contribution in facing the disease itself. We surveyed neurosurgeons worldwide to investigate the situation they are experiencing. Design and participants A 17-question, web-based survey was administered to neurosurgeons worldwide through the WFNS and the Neurosurgery Cocktail from March 28 to April 5, 2020 by web link or e-mail invitation. Questions were divided into three subgroups: general information, health system organization, and institutional plans for the SARS-CoV-2 outbreak. Collected data was initially elaborated using Survey Monkey® software. Country specific data were extracted from the WHO website. Statistical analysis was performed using R version 3.6.3. Results Of the 446 respondents, most were from Italy (20%), India (19%), and Pakistan (5%). Surgical activity was significantly reduced in most centers (79%) and dedicated in-hospital routes were created for SARS-CoV-2 patients (58%). Patient screening was performed only when there were symptoms (57%) and not routinely before surgery (18%). The preferred methods included a nasopharyngeal swab and chest x-ray. Health professionals were rarely screened (20%) and sometimes, even if SARS-CoV-2 positive, were asked to work if asymptomatic (26%). Surgical planning was changed in most institutions (92%), while indications were modified for non-urgent procedures (59%) and remained unchanged for subarachnoid hemorrhages (85%). Conclusions Most neurosurgeons worldwide reported work reorganization and practices that respond to current international guidelines. Differences in practice might be related to the perception of the pandemic and significant differences in the health systems. Sharing data and experiences will be of paramount importance to address the present moment and challenges in the near future.