An Exit Strategy for Resuming Nonemergency Neurosurgery after Severe Acute Respiratory Syndrome Coronavirus 2: A United Kingdom Perspective

Abstract

Substantial healthcare resources have been diverted to manage the effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, and nonemergency neurosurgery has been effectively closed. As we begin to emerge from the crisis, we will need to manage the backlog of nonemergency neurosurgical patients whose treatment has been delayed and remain responsive to further possible surges of SARS-CoV-2 infections.-METHODS: In the present study, we aimed to identify the core themes and challenges that will limit resumption of a normal neurosurgical service after the SARS-CoV-2 pandemic and to provide pragmatic advice and solutions that could be of utility to clinicians seeking to resume nonemergency neurosurgical care. We reviewed the relevant international policies, a wide range of journalistic and media sources, and expert opinion documents to address the stated aims.-RESULTS: We have presented and discussed a range of factors that could become potential barriers to resuming full elective neurosurgical provision and important steps that must be completed to achieve preeSARS-CoV-2 surgical capacity. We also explored how these challenges can be overcome and outlined the key requirements for a successful neurosurgical exit strategy from the pandemic.-CONCLUSION: The performance of nonemergency neurosurgery can start once minimum criteria have been fulfilled: 1) a structured prioritization of surgical cases; 2) virus infection incidence decreased sufficiently to release previously diverted healthcare resources; 3) adequate safety criteria met for patients and staff, including sufficient personal protective equipment and robust testing availability; and 4) maintenance of systems for rapid communication at organizational and individual levels.

The impact of coronavirus 2019 (COVID-19) on neurosurgical practice and training: a review article

“…They determined four criteria that should be fulfilled prior to resuming elective neurosurgical procedures: (1) structured prioritization of neurosurgical cases; (2) decreased incidence of COVID-19 infection; (3) adequate testing of all elective neurosurgical patients; (4) coordination of strategy at individual and organizational levels. 43…”

Reconversion of neurosurgical practice in times of the SARS-CoV-2 pandemic: a narrative review of the literature and guideline implementation in a Mexican neurosurgical referral center

“…15 In China, 3.8% (n = 1716 of 44,672) of COVID-19 cases occurred in healthcare personnel, 14.8% (n = 254) of which were severe; in Lombardy, Italy, 20% of the cases occurred in healthcare work-ers. 16,17 Subsequent reports suggested that the first nosocomial spread event occurred during pituitary surgery in which 14 people were exposed and infected in China. 18…”

“…34 During the preoperative period, a thoracic CT scan and nucleic acid sequencing (reverse-transcription polymerase chain reaction [RT-PCR]) are performed for the preliminary diagnosis of COVID-19; however, the chances of a false-negative test result have been reported to be as high as 16.7%. 17 Patients with positive results are identified as having confirmed COVID-19, and patients with prelimi-nary negative results are considered suspect for having COVID-19. Therefore, various levels of protection and specific adaptations to operating rooms occur in a negative pressure environment with access routes specifically designated for all suspect or confirmed cases.…”

In Reply to the Letter to the Editor Regarding “Impact of COVID-19 on an Academic Neurosurgery Department: The Johns Hopkins Experience”

“… 3 Regarding hospital operations specifically, institutional exit strategies such as that proposed by Hill et al. 4 for resuming nonemergency neurosurgical operations will likely prove crucial in gradually moving toward prepandemic caseloads and maintaining the necessary precautions required to ensure both patient and hospital staff safety. Although such guidelines will most likely vary between different institutions, the common themes that have been consistently described in reported studies have included ensuring the availability of personal protective equipment for healthcare workers, continuing the use of telemedicine within neurosurgical workflows, and working to balance the increased surgical demand with the available hospital resources.…”

“…Although such guidelines will most likely vary between different institutions, the common themes that have been consistently described in reported studies have included ensuring the availability of personal protective equipment for healthcare workers, continuing the use of telemedicine within neurosurgical workflows, and working to balance the increased surgical demand with the available hospital resources. 4 , 5 , 6 , 7 , 8 , 9 As pandemic restrictions are eased and surgical volumes increase, it will also be important to identify those patients requiring urgent neurosurgical intervention. Guides for prioritizing neurosurgery cases, such as that proposed by Thomas et al., 10 using the Delphi method, will likely become increasingly important as surgeons aim to clear the case backlogs that have accumulated during the height of the pandemic.…”