Impact of COVID-19 pandemic on the neurosurgical practice in Egypt

Abstract

Background The COVID-19 pandemic and the subsequent lockdown have significantly altered many aspects of the health care services. We investigated the impact of the restrictive measures during the pandemic on the volume and spectrum of operated neurosurgical cases at two University hospitals in Egypt. Results The total number of surgeries dropped during the lockdown (second quarter of the year 2020) by 38%, compared with the total number of surgeries in the first quarter of the same year, with an increase in the proportion of urgent surgeries to the total number of surgeries from 46 to 69% (P < 0.001), and a decrease in the proportion of elective surgeries from the total number of neurosurgeries from 54 to 31% (P < 0.001). Similar differences were noted in the volume and spectrum of surgeries in the second quarter of 2020, when compared to the same period of the preceding year (2019). Conclusions The COVID-19 pandemic has significantly altered the nature and volume of neurosurgical practice. The overall number of surgeries showed a marked decline in the lockdown period; however, the numbers of urgent surgeries showed no significant difference under the lockdown.

A look at the global impact of COVID-19 pandemic on neurosurgical services and residency training

“…Eight studies reported the case volume of elective neurosurgical procedures performed both before and during the COVID-19 pandemic. [ 27 , [37] , [38] , [39] , [40] , 47 , 50 , 54 ] Collectively, the number of elective surgeries decreased by 70.4% (OR=0.296, 95% CI 0.210–0.418, p <0.001) ( Figure 2 A). A comparison of non-elective neurosurgical procedures was reported in 9 studies, with an overall decrease of 68.2% (OR=0.318, 95% CI 0.193–0.525, p <0.001) ( Figure 2 B).…”

“…After removing duplicates, 935 articles were left; their titles and abstracts were screened, and 78 relevant articles were identified for full-text review. Overall, this study collated data and information from 49 articles, [ 11 , 12 , 17 , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] ] with 25 of them included in the quantitative synthesis ( Figure 1 ). Twenty-two of these articles were retrospective in nature, two had data collected both retrospectively and prospectively, one was both a retrospective cohort study and a survey.…”

“…Majority of the included studies observed a significant decrease in overall caseloads, both surgical and non-surgical, resulting in diminished clinical exposure for residents. [ 12 , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [30] , [31] , [32] , [33] , 35 , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] ] Ashry et al found that 56% of the residents had a reduction in their actual role in the surgical steps and the number of residents scrubbing in the same procedure had been decreased to the minimum for preservation of personal protective equipment (PPE). [21] A survey completed by El-Ghandour and colleagues revealed that elective surgery/clinic cancellation occurred more frequently in African countries and that theyr were utilizing PPE significantly less commonly in LMICs (OR=0.441, 95% CI 0.216-0.900, p <0.05).…”

“…[ 23 , 24 ] Fifth studies reported a formal reduction of resident presence, with a significant decrease in working hours and responsibility. [ 21 , 22 , 26 , [30] , [31] , [32] , 35 , 40 , 44 , 50 , [56] , [57] , [58] , 62 , 64 ] However, some residents experienced increased burdens and anxiety due to the extra work caused by the pandemic, including redeployment to help manage COVID-19 patients or COVID-related problems when needed. [ 12 , 21 , 42 , 44 ] Moreover, the reduction in operative volumes and clinical experiences has caused concern amongst residents about meeting their annual training requirements.…”

Surgical Protocols before and after COVID-19—A Narrative Review

“…A study examined the amount and type of neurosurgery patients that had been treated at two teaching hospitals in Egypt under the pandemic’s restrictive measures [ 18 ]. With the proportion of urgent procedures rising from 46 to 69% of all surgeries and the proportion of elective surgeries falling from 54 to 31% of all neurosurgeries, according to the study, the number of surgeries had decreased by 38% during the lockdown (second quarter of 2020) compared to total number of surgeries in the 1st quarter of same year.…”