Path to Reopening Surgery during the COVID-19 Pandemic: Neurosurgery Experience

De Biase, Gaetano; Freeman, William; Elder, Benjamin D; Nottmeier, Eric W; Abel, Martin; Quiñones-Hinojosa, Alfredo; Abode-Iyamah, Kingsley

INTRODUCTION: The COVID-19 pandemic created a major public health threat to patients and health care systems around the world. Many hospitals cancelled elective surgeries to brace for the pandemic thus impacting many neurosurgical patients that had their surgeries postponed. METHODS: We implemented several measures for staff and patients to minimize the risk of exposure to SARS-CoV-2. For surgical clearance, all patients needed to be tested for SARS-CoV-2 within 48h prior to the non-elective surgery. A triage protocol was implemented to manage patients in need of non-elective surgeries. A “drive-through” testing center was developed for preoperative surgical clearance to triage cases in need of non-elective surgery. Similarly, all patients admitted to the hospital were tested. Telemedicine played a big role in evaluating the need of surgery. We reviewed the clinical, radiographic, and laboratory data for all patients that underwent surgery within the neurosurgery department from March 26th to April 22nd 2020. RESULTS: Using a combination of preoperative outpatient COVID-19 drive-through and inpatient testing to help obtain surgical clearance with selected telemedicine evaluations, 103 non-elective neurosurgical procedures were performed on 102 patients. No patients tested positive for the COVID-19 testing prior to surgery. None of the operated patients developed any COVID-19 symptoms during their hospitalization or were re-admitted to our ED postoperatively for COVID-19 symptoms. A subset of patients developed symptoms suspect for COVID-19 post-operatively but were retested and all tested negative. CONCLUSION: We describe a multi-faceted preoperative triage protocol for safely performing non-elective neurosurgical cases during the COVID-19 pandemic, which could help other neurosurgical departments and hospitals minimize coronavirus exposure for patients and healthcare workers. We believe this triage strategy helps safely identify selected patients in need of neurosurgical care amidst hospital capacity concerns, COVID-19 testing limitations, limited personal protective equipment, and this approach could be implemented at other centers to gradually restart a process towards elective surgeries in a safe way.