Surgical Prioritization: The Northwell Neurosurgical Prioritization Initiative

INTRODUCTION Beginning in March, 2020, hospitals across the majority of the United States were required to cancel all elective surgery in preparation for a surge of patients with the coronavirus disease of 2019 (COVID-19) A large number of neurosurgical patients with less than emergency conditions had their surgery postponed indefinitely METHODS The Delphi method was used to obtain consensus Twenty-two neurosurgeons actively practicing in two separate geographic regions of the United States where “black level” COVID-19 surges occurred (New York Metropolitan Area and Detroit, Michigan) participated A total of 86 neurosurgical case scenarios were categorized into six tiers of priority: emergent or within 24 hours, within 48 hours, within 1 week, within 2 weeks, within one month, or post hospital crisis/more than 4 weeks Consensus was defined as 75% of participants reaching an agreement Majority opinion (>50% agreement) was also reported RESULTS 67 of the 86 surgical scenarios (78%) reached a consensus agreement with 85 out of 86 scenarios reaching at least a majority opinion Only one scenario (central cord syndrome) did not reach any agreement CONCLUSION The NNPI developed in this study can assist neurosurgical departments in prioritizing the timing of surgery, whether it be due to a pandemic, or any other scenario where the normal work flow has been severely disrupted and resources are limited