Case Volumes and Perioperative COVID-19 Incidence in Neurosurgical Patients During a Pandemic: Experiences at Two Tertiary Care Centers in Washington, DC.

ABSTRACT Objective The true incidence of perioperative COVID-19 is not well elucidated in the neurosurgical literature. We aim to review the impact of the pandemic on neurosurgical case volume, to study the incidence of COVID-19 in patients undergoing these procedures during the perioperative period, and to compare characteristics and outcomes of this group to COVID-19 negative patients. Methods Neurosurgical and neurointerventional procedures at two tertiary care centers during the pandemic were reviewed. Case volume, type, and acuity were compared to same time period in 2019. Perioperative COVID-19 tests and results were evaluated to obtain incidence. Baseline characteristics, including a modified Medically Necessary Time Sensitive (mMeNTS) score, and outcome measures were compared between COVID-19 positive and negative patients. Results 405 cases were reviewed and there was a significant decrease in total spine, cervical spine, lumbar spine, and functional/pain cases. There were no significant differences in cranial and neurointerventional cases. Of patients tested, 5.4% (18/334) were positive for COVID-19. Five of these patients were diagnosed postoperatively. mMeNTS score, complications, and case acuity were significantly different between COVID-19 positive and negative patients. Conclusion There is a small but real risk of perioperative COVID-19 in neurosurgical patients, and those patients tend to have a higher complication rate. The mMeNTS score may play a role in decision making for scheduling elective cases. Further studies are warranted to develop risk stratification and validate incidence.