The impact of SARS-CoV-2 measures on patient samples and complication rates in spine surgery – A single center analysis

Abstract

ObjectiveOver the past two years during the pandemic, the German health system has taken drastic measures, like the continuous use of face masks for all staff, restrictions of hospital visits as well as cancellation of elective surgical procedures. As a potential side effect of these measures, a significant reduction of surgical site infections was reported for neurosurgical patients. The purpose of our study was to analyze the impact of these measures on spinal surgery.MethodsWe performed a retrospective analysis to compare patient samples, procedures and infection rates before (January 2019 – March 2020) and during (April 2020 – June 2021) the pandemic to evaluate the impact of the measures mentioned above. Demographic and clinical data were collected and correlated with the occurrence of postoperative complications, especially infection.ResultsOur analysis showed no relevant decrease of spine surgeries (838 surgeries in non-pandemic group vs. 831 surgeries pandemic group). The most common postoperative complication was wound infection in both groups, followed by urinary tract infection and pneumonia. In both patient groups, infections were more prevalent in surgeries of multilevel posterior instrumentation. Comparing the two groups of patients, a slight, non-significant (0.5%) reduction of overall postoperative complications in the pandemic group was observed. However, the number of spinal surgeries classified as emergencies in our institution increased by 10.2% during the last 15 months of the COVID-19 pandemic. In line with this finding the urgent transfer of patients from smaller hospitals increased by 14.2%, compared to previous years.ConclusionThe volume of spinal surgeries remained high and complication rates stable during the pandemic. A reason why complication rates did not drop as reported previously might be a significant change in patient sample due to the increase of emergency surgeries. A decrease of complication rates, especially infections by the measures of infection prevention for the pandemic was not observed.

Editorial: The impact of COVID-19 on immune system-related complications in surgical patients

“…An authoritative review from an international consensus group coherently summarized the current state-of-the-art in the field as it pertains to the pathogenesis of SARS-CoV-2-mediated immune-thrombotic complications after surgery Bunch et al The authors introduced the new entity of "COVID-associated coagulopathy" and explained the underlying hypothesis related to SARS-CoV-2-induced endothelitis as the root cause of an imbalance between fibrinolysis and fibrinolytic shutdown Bunch et al The clinical implications pertain to adjudicating the timing of elective surgical procedures in COVID-19 patients and to monitor the "rollercoaster" stages of COVID-associated coagulopathy by point-of-care-guided viscoelastic hemostatic assays, such as thromboelastography (Figure 1). The authors furthermore provided specific clinical recommendations for perioperative anticoagulation in COVID-19 patients for a variety of surgical subspecialties, including general surgery, cardiothoracic and (22). The authors attributed the lack of decreased surgical site infections, in spite of the COVID-19 preventative measures, to higher rates of emergency surgical spine procedures during the pandemic (22).…”

“…The authors furthermore provided specific clinical recommendations for perioperative anticoagulation in COVID-19 patients for a variety of surgical subspecialties, including general surgery, cardiothoracic and (22). The authors attributed the lack of decreased surgical site infections, in spite of the COVID-19 preventative measures, to higher rates of emergency surgical spine procedures during the pandemic (22). The special edition concludes with a case report on three patients with COVID-19 who sustained severe osteomyelitis of the jaw as a rare but severe infectious complication Kvolik Pavic et al The authors hypothesized that the SARS-CoV-2-induced immune dysfunction and microvascular changes contributed to the increased vulnerability for severe infection in patients with COVID-19 Kvolik Pavic et al…”

“…While the root cause of the decrease in PROMs remains speculative, the authors recommend consideration for psychological support for surgical patients during the pandemic to improve postoperative outcomes Lin et al . A similar publication from Germany reported unchanged infectious complication rates after spinal surgery during the COVID-19 pandemic from April 2020 to June 2021, when compared to a historic pre-pandemic cohort of spine surgery patients managed at the same institution from January 2019 until March 2020 ( 22 ). The authors attributed the lack of decreased surgical site infections, in spite of the COVID-19 preventative measures, to higher rates of emergency surgical spine procedures during the pandemic ( 22 ).…”

“…A similar publication from Germany reported unchanged infectious complication rates after spinal surgery during the COVID-19 pandemic from April 2020 to June 2021, when compared to a historic pre-pandemic cohort of spine surgery patients managed at the same institution from January 2019 until March 2020 ( 22 ). The authors attributed the lack of decreased surgical site infections, in spite of the COVID-19 preventative measures, to higher rates of emergency surgical spine procedures during the pandemic ( 22 ). The special edition concludes with a case report on three patients with COVID-19 who sustained severe osteomyelitis of the jaw as a rare but severe infectious complication Kvolik Pavic et al .…”

The Impact of the COVID-19 Pandemic in Postoperative Neurosurgical Infections at a Reference Center in México

“…Reports from developed countries suggested that the pandemic conditioned a slight reduction in operative capacities, and affected mainly elective procedures [ 4 , 5 ]. Some centers reported an increase in the number of urgent procedures with stable complication rates, and no higher mortality rate than had been reported in the pre-pandemic period [ 6 , 7 ]. Developing countries with higher healthcare system stress reported a considerable impact by decreasing the number of scheduled surgeries, increasing the proportion of urgent surgeries, and increasing the proportion of emergency surgeries [ 8 , 9 ], while in other countries there was an increase in hospital mortality and in the cost of procedures [ 10 ].…”