Perioperative COVID-19 Incidence and Outcomes in Neurosurgical Patients at Two Tertiary Care Centers in Washington, DC During a Pandemic: A 6-month Follow-up

Abstract

Objective

Coronavirus disease 2019 (COVID-19) continues to affect all aspects of healthcare delivery and neurosurgical practices are not immune to its impact. We aim to evaluate neurosurgical practice patterns as well as perioperative incidence of COVID-19 in neurosurgical patients and their outcomes.

Methods

A retrospective review of neurosurgical and neurointerventional cases at two tertiary centers during the first three months of the first peak of COVID-19 pandemic (March 8-June 8) as well as following three months (post-peak pandemic; June 9-September 9) was performed. Baseline characteristics, perioperative COVID-19 test results, modified Medically Necessary Time Sensitive (mMeNTS) score, and outcome measures were compared between COVID-19 positive and negative patients through bivariate and multivariate analysis.

Results

652 neurosurgical and 217 neurointerventional cases were performed during post-peak pandemic period. Cervical spine, lumbar spine, functional/pain, cranioplasty, and cerebral angiogram cases were significantly increased in the post-pandemic period. There was a 2.9% (35/1,197) positivity rate for COVID-19 testing overall and 3.6% (13/363) positivity rate postoperatively. Age, mMeNTS score, complications, length of stay, case acuity, ASA status, length of stay, and disposition were significantly different between COVID-19 positive and negative patients.

Conclusion

A significant increase in elective case volume during the post-peak pandemic period is feasible with low and acceptable incidence of COVID-19 in neurosurgical patients. COVID-19 positive patients were younger, less likely to undergo elective procedures, had increased length of stay, had more complications, and were discharged to a location other than home. The mMeNTS score plays a role in decision making for scheduling elective cases.