Neurosurgery and Coronavirus: Impact and Challenges. Lessons Learnt from the First Wave of a Global Pandemic

Background: The novel severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has had a drastic effect on global healthcare with the UK amongst the countries most severely impacted. The aim of this study was to examine how COVID-19 challenged the neurosurgical delivery of care in a busy tertiary unit serving a socio-economically diverse population. We also describe the strategies we adopted to meet these challenges. Methods: A prospective single centre cohort study including all patients referred to the acute neurosurgical service or the subspecialty multi-disciplinary teams (MDT) as well as all emergency and elective admissions during COVID-19 (18th March 2020-15th May 2020) compared to pre-COVID-19 (18th of January 2020-17th March 2020). Data on demographics, diagnosis, operation, and treatment recommendation/outcome were collected and analysed. Findings: Overall, there was a reduction in neurosurgical emergency referrals by 33·6% and operations by 55·6% during the course of COVID-19. There was a significant increase in the proportion of emergency operations performed during COVID-19 (75·2% of total, n=155) when compared to pre-COVID-19 (n=198, 43·7% of total, p<0.00001). The 30-day perioperative mortality remained low at 2·0% with the majority of patients who contracted post-operative COVID-19 infection (n=13) having underlying medical co-morbidities and/or suffering from post-operative complications. Interpretation: Despite the challenges, the capacity to safely treat patients requiring urgent or emergency neurosurgical care was maintained at all times. Strategies adopted to enable this included proactively approaching the referrers to maintain lines of communications, incorporating modern technology including telemedicine to run clinics and MDTs, restructuring patient pathways/facilities into COVID-19 positive and non-COVID-19, re-organising the staff rotas, and initiating the delivery of NHS care within private sector hospitals to increase operative capacity. We believe lessons learned here will have direct relevance for neurosurgical care during the current and future pandemics. Funding: Nil. Declaration of Interest: None of the authors have any conflict of interest or financial disclosure. Ethics Approval Statement: Local ethical approval was obtained.