Impact of a pandemic on surgical neuro-oncology—maintaining functionality in the early phase of crisis

Abstract

Background The Coronavirus disease 2019 (COVID-19) pandemic has extraordinarily impacted global healthcare. Neuro-oncological surgery units have peculiar features that make them highly relevant in the strategic reaction to the pandemic. In this Chinese Society of Neuro-Oncology (CSNO) initiated survey, we appraise the changes implemented in neuro-oncological surgery hospitals across different Asian countries and provide expert recommendations for responses at different stages of the pandemic. Methods We performed a 42-question survey of the early experience of neuro-oncological surgery practice in hospitals across different Asian countries on April 1, 2020, with responses closed on April 18, 2020. Results 144 hospitals completed the questionnaire. Most were in WHO post-peak phase of the pandemic and reported a median reduction in neuro-oncological surgery volume of 25–50%. Most (67.4%) resumed elective surgery in only COVID-19 negative patients;11.1% performed only emergency cases irrespective of COVID-19 status;2.1% suspended all surgical activity. Ninety-one (63.2%) relocated personnel from neurosurgery to other departments. Fifty-two (36.1%) hospitals suspended post-operative adjuvant therapy and 94 (65.2%) instituted different measures to administer post-operative adjuvant therapy. Majority (59.0%) of the hospitals suspended research activity. Most (70%) respondents anticipate that current neurosurgery restrictions will continue to remain for > 1 month. Conclusions Majority of the respondents to our survey reported reduced neuro-oncological surgery activity, policy modification, personnel reallocation, and curtailment of educational/research activities in response to the COVID-19 pandemic. The persistent widespread interruption of surgical neuro-oncology in even post-peak phases of the pandemic raises serious concerns about the long-term impact of the pandemic on neuro-oncological patients and highlights the essence of timely measures for pandemic preparedness, patient triage, and workforce protection.

Practice Patterns in Surgical Neuro-Oncology Among Low- and Middle-Income Countries During the Coronavirus Disease 2019 Pandemic: A Scoping Review and Situational Report from the Philippines

“…Included studies were from India ( n = 6), 21 , 22 , 23 , 24 , 25 , 26 China ( n = 2), 19 , 20 Brazil ( n = 1), 18 Iran ( n = 1), 27 Turkey ( n = 1), 28 and multiple Asian countries (most from China). 29 Study types were case-control ( n = 6), 20 , 21 , 22 , 25 , 26 , 27 expert opinion and review ( n = 3), 18 , 23 , 28 cross-sectional survey ( n = 1), 29 retrospective cohort ( n = 1), 24 and letter to the editor with case report ( n = 1). 19 …”

“…All studies used a triaging system to classify patients requiring surgery according to urgency. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 In general, emergent or urgent surgical treatment was recommended for patients with brain tumors with significant size and mass effect, malignant tumors, or those in herniation. Patients with benign asymptomatic tumors were deemed non- elective and had the least priority.…”

“…All studies recommended COVID-19 screening with reverse transcriptase polymerase chain reaction (RT-PCR) for all patients undergoing surgical neuro-oncology procedures. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 Two studies required a pulmonary high-resolution computed tomography (HRCT) scan in addition to the RT-PCR test. 18 , 27 One study recommended the use of a COVID-19 rapid antigen test in patients who needed acute and emergent treatment while waiting for the RT-PCR.…”

“…All studies were consistent in using level I PPE for COVID-19–negative patients and level III PPE for COVID-19–positive patients. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 …”

“…Most (11/12, 91.7%) of the studies reported a decrease in OR availability during the pandemic, 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 for the following reasons: ORs being used as ICUs, ORs being used as donning/doffing areas, 25 or decreasing OR capacity to increase personnel availability for patients with COVID-19. 29 Eight studies 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 (66.7%) reported decreasing OR personnel both to reduce their exposure and to reallocate them to other areas. Only 3 studies reported the availability of a negative-pressure OR for COVID-19–positive patients.…”