The Demand for Elective Neurosurgery at a German University Hospital during the First Wave of COVID-19

Abstract

Background: Patients’ fear of the coronavirus disease 2019 (COVID-19) may delay inevitable treatment, putting potential benefits at risk. This single-center retrospective study aims to analyze temporal relationships of the first wave of the COVID-19 pandemic in Germany with the number of patients who sought and received elective neurosurgical treatment at a German university hospital. Methods: Daily outpatient numbers (ON) and elective procedures (EP) were recorded at our department between 1 January 2020 and 30 June 2020 (baseline: between 1 January 2019 and 30 June 2019). In patients who received EP, we recorded indication, outcome, and length of stay (LOS). Moving averages of ON (MAON) and of EP were calculated. Data on governmental action taken in response to the pandemic and on coronavirus-positive cases in Germany (CPCG) were superimposed. Exponential and arc tangent curves (ATC) were fitted to the absolute numbers of CPCG. Phase shifts were estimated, and Spearman’s rank correlation coefficient, rho, was calculated between the 2020 MAON and the derivative function of the fitted ATC (DFATC). Wilcoxon rank sum served as statistical test. Significance was assumed with p values of less than 0.05. Results: ON were significantly decreased in April 2020 as compared to April 2019 (p = 0.010). A phase shift between the German lockdown, the DFATC, and the decrease in MAON was not detected, while a phase shift of 10 days between the DFATC and the subsequent increase in MAON was detected. The DFATC was significantly negatively correlated (rho = −0.92, p < 0.0001) to the MAON until 31 March 2020, and, when shifted by 10 days, the DFATC was significantly negatively correlated (rho = −0.87, p < 0.0001) to the MAON from 01 April 2020. EP (p = 0.023), including the subset of non-oncological EP (p = 0.032), were significantly less performed in the first half of 2020 as compared to the first half of 2019. In March and April 2020, we conducted significantly more EP due to motor deficits (p = 0.0267, and less), visual disturbances (p = 0.0488), and spinal instability (p = 0.0012), and significantly less EP due to radicular pain (p = 0.0489), as compared to March and April 2019. LOS ranked significantly higher in patients who received cranial or spinal EP in March and April 2020 as compared to March and April 2019 (p = 0.0497). Significant differences in outcome were not observed. Conclusion: The beginning of the COVID-19 pandemic was correlated to an immediate and significant decrease in ON, and to a significant decrease in the number of EP performed. The subsequent increase in ON was delayed. Adequate measures to promote timely discharge of patients may become increasingly relevant as the pandemic proceeds. Although we observed a shift in the range of indications towards significantly more EP in patients with neurological deficiencies, care should be taken to avoid potentially deleterious delays of necessary elective treatment in future pandemic situations.

Impact of the COVID-19 pandemic on oncological care in Germany: rapid review

“…1 ). These included 59 peer-reviewed studies (Arndt et al 2022 ; Balakirski et al 2022 ; Balk et al 2022 ; Bartella et al 2021 ; Beller et al 2022 ; Bollmann et al 2021 ; Brunner et al 2020 ; Buntzel et al 2020 , 2021 ; Dienemann et al 2021 ; Diers et al 2021 , 2022 ; Donath et al 2021 ; Eckford et al 2021 ; Erdmann et al 2021 , 2022 ; Fauser et al 2022 ; Gremke et al 2022 ; Griewing et al 2022a , b ; Gschnell et al 2021 ; Haier et al 2022a , b , c ; Hajek et al 2021 ; Harke et al 2020 , 2022 ; Heimes et al 2021 ; Holzel et al 2022 ; Hunger et al 2022 ; Jacob et al 2021 , 2022 ; Jördens et al 2021 ; Justenhoven and Rieger 2022 ; Kaltofen et al 2022 ; Kapsner et al 2020 ; Kirchberg et al 2021 ; Kleemann et al 2022 ; Kourtidis et al 2022 ; Kuhlen et al 2020 ; Matuschek et al 2020 ; Medenwald et al 2022 ; Micek et al 2022 ; Michalowsky et al 2021 ; Piontek et al 2021 ; Reichardt et al 2021 ; Riemann et al 2021 ; Rupa et al 2020 ; Schuz et al 2022 ; Stang et al 2020 ; Stos et al 2020 ; Struck et al 2022 ; Teuscher et al 2022 ; Voigtlander et al 2021 ; Vu et al 2022 ; Walter et al 2021 , ...…”

Dynamics in the Neurotrauma Catchment Area of a German University Hospital during the COVID-19 Pandemic

“…In the beginning of 2020, the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) [ 4 ], brought about a demand to quickly reallocate healthcare resources [ 5 , 6 ]. Subsequently, we and other neurosurgeons [ 7 , 8 ] were concerned about the possibility of an involuntary triage of neurosurgical patients due to the pandemic.…”

Letter to the Editor: Commentary on Does the COVID-19 Screening Test Affect the Postoperative Prognosis of Patients Who Undergo Emergency Surgery for Cerebral Hemorrhage? (Korean J Neurotrauma 2022;18:198–207)

“…Several studies have been conducted on protocols or surgical recommendations for neurosurgery in patients with COVID-19. 1 2 4 5 6 7) Lee et al 4) developed a clinical pathway for patients indicated for emergency brain surgery from the emergency room, applied it to the actual clinical field, and published it. These studies are thought to enable a sufficient response in a wide range of outbreaks of not only COVID-19, but also other various respiratory diseases that may occur in the future.…”