Less surgical site infections in neurosurgery during COVID-19 times—one potential benefit of the pandemic?

Abstract

Hygiene measures were intensified when the COVID-19 pandemic began. Patient contacts were limited to a minimum. Visitors were either not allowed for a certain period or limited for the rest of the time. The hospital staff began to wear masks and gloves continuously. Clinical examinations and routine wound controls were also performed under intensified hygiene standards. These circumstances result in a limitation of direct physical interactions between the nursing staff, the physicians and the patients. We analyzed to what extent the intensification of hygiene measures affects the rate of surgical site infections (SSI) after neurosurgical procedures. The rate of SSI during the 6-month interval after the beginning of COVID-19 measures was compared with the SSI rate before. The numbers of the period before COVID-19 were analyzed as mean values resulting from the analysis of two separate time periods each consisting of 6 months. The spectrum of surgical procedures was compared. Patient-related risk factors for SSIs were noted. Microorganisms were analyzed. We focused on SSIs occurring at a maximum of 60 days after the primary surgery. Overall, in the two respective 6-month periods before COVID-19, a mean of 1379 patients was surgically treated in our institution. After the beginning of COVID-19 (starting from 04/2020) our surgical numbers dropped by 101, resulting in a total number of 1278 patients being operated after 03/2020 until 09/2020. The SSI rate was 3.6% (03/2019–09/2019, 50 SSIs) and 2.2% (09/2019–03/2020, 29 SSIs), resulting in a mean of 2.9% before COVID-19 began. After the beginning of COVID-19 hygiene measures, this rate dropped to 1.4% (16 SSIs) resembling a significant reduction (p=0.003). Risk factors for the development of SSI were present in 81.3% of all patients. Pre- and post-COVID-19 patient groups had similar baseline characteristics. The same holds true when comparing the percentage of cranial and spinal procedures pre- and post-COVID-19 (p=0.91). Comparing the numbers (p=0.28) and the species (p=0.85) of microorganisms (MO) causing SSI, we found a similar distribution. Despite equal demographics and characteristics of SSI, the rate of SSI dropped substantially. This argues for an effective reduction of postoperative SSI resulting from the implementation of strict hygiene measures being established after the beginning of the COVID-19 pandemic. We therefore advocate continuing with strict and intensive hygiene measures in the future.

The Impacts of COVID-19 on Healthcare Quality in Tertiary Medical Centers—A Retrospective Study on Data from Taiwan Clinical Performance Indicators System

“…Elective medical services declined markedly during the outbreak of COVID-19 in Taiwan [ 12 ]. The same phenomenon was observed similarly all over the world [ 2 , 3 , 4 , 6 , 7 ]. People were less willing to visit a hospital for fear of COVID-19, which was known to be contagious disease at the outset of the outbreak [ 13 ].…”

“…Other explanations could be the healthcare systems as well as cultural backgrounds of Taiwan and Spain being dissimilar. Previous studies indicated that there were significant differences in postoperative infections during the outbreak of COVID-19 [ 5 , 6 ]. However, as less than three-quarters of the medical centers in Taiwan uploaded their surgical site infection rate, we did not analyze these data.…”

“…In contrast, a study from Italy indicated that the overall surgical site infection rate was lower in the COVID-19 era when compared with that of the pre-COVID-19 period [ 5 ]. In addition, the surgical site infection rate after neurosurgery during the COVID-19 pandemic was lower when compared with that before the COVID-19 outbreak [ 6 ]. A UK-based multicenter retrospective national survey of patients who underwent foot and ankle surgery before, during, and after a national lockdown showed that the postoperative infection rate remained similar among these three periods [ 7 ].…”

Neurosurgical Care during the COVID-19 Pandemic in Central Germany: A Retrospective Single Center Study of the Second Wave

“…It should be emphasized, however, that a trend for less SSI among patients receiving neurosurgical care was evident during the pandemic, but this difference was not statistically significant. A recently published study in a large neurosurgical center in Germany described a drastic decrease in SSI after neurosurgical procedures due to the strict hygiene measures and limited visitors in the hospital [14]. It should be underlined that in our study 29 cases (28.34% of all complications in the pandemic group) versus 28 cases (30.11% of all complications in the pre-pandemic group, p-value 0.588) were identified.…”

“…Interestingly, there were also few European centers that reported no decreases in the quantity and quality of medical care of neurosurgical procedures, elective as well as emergency cases due to the pandemic [4]. Another study of neurosurgical patients during the COVID-19 pandemic in Germany found a slight decrease in patients and (1278 cases pandemic versus 1379 pre-pandemic) and surgical procedures [14].…”