key: cord-0826168-ygd19p05
authors: Rothrock, Robert J.; Maragkos, Georgios A.; Schupper, Alexander J.; McNeill, Ian T.; Oermann, Eric K.; Yaeger, Kurt A.; Gilligan, Jeffrey; Bederson, Joshua B.; Mocco, J. D.
title: By the Numbers Analysis of COVID-19’s Effect on a Neurosurgical Residency at the Epicenter
date: 2020-07-17
journal: World Neurosurg
DOI: 10.1016/j.wneu.2020.07.063
sha: 9b136abf3374ada1abbf5169ddc23bf9f5402a35
doc_id: 826168
cord_uid: ygd19p05

Abstract Background The SARS-CoV-2 pandemic has created challenges to neurosurgical patient care. Despite editorials evaluating neurosurgery COVID-19 responses, data reporting COVID-19’s effects on case volume, census, and resident illness are lacking. Objective To present areal-world analysis of neurosurgical volumes, resident deployment, and unique challenges encountered during the SARS-CoV-2 outbreak peak in New York City. Methods Daily census and case volume data were prospectively collected throughout the Spring 2020SARS-CoV-2 outbreak. Neurosurgical census was compared against COVID-19 system-wide data. Neurosurgical cases during the crisis were analyzed and compared to seven-week periods from 2019 and 2020. Resident deployment and illness were reviewed. Results From March 16-May 5, 2020, residents participated in 72 operations and 69 endovascular procedures. This compares to 448 operations and 253 endovascular procedures in January-February 2020 and 530 operations and 340 endovascular procedures over March-May 2019. There was a 59% reduction in neurosurgical census during the outbreak (median 24 patients, 2.75 average total cases daily). COVID-19 neurosurgical admissions peaked in concert with the system-wide pandemic. Three residents demonstrated COVID-19 symptomatology (no hospitalizations occurred) for a total 24 workdays lost (median 7 days). Conclusion These data provide real-world guidance on neurosurgical infrastructure needs during a COVID-19 outbreak. While re-deployment to support the COVID-19 response was required, there remained a significant need to continue to provide critical neurosurgical service.

Daily census and case volume data were prospectively collected throughout the Spring 12 2020SARS-CoV-2 outbreak. Neurosurgical census was compared against COVID-19 system-13 wide data. Neurosurgical cases during the crisis were analyzed and compared to seven-week 14 periods from 2019 and 2020. Resident deployment and illness were reviewed. There was a 59% reduction in neurosurgical census during the outbreak (median 24 patients, 21 2.75 average total cases daily). COVID-19 neurosurgical admissions peaked in concert with the 22 system-wide pandemic. Three residents demonstrated COVID-19 symptomatology (no 23 hospitalizations occurred) for a total 24 workdays lost (median 7 days).

These data provide real-world guidance on neurosurgical infrastructure needs during a COVID-27 19 outbreak. While re-deployment to support the COVID-19 response was required, there 28 remained a significant need to continue to provide critical neurosurgical service.

The global pandemic associated with the novel coronavirus SARS-CoV-2, causing the 37 coronavirus disease 2019 (ARDS). The majority of hospital and departmental resources were requested towards this 53 effort. However, a significant burden of neurological disease was also encountered during this 54 period. 55 We report numerical real-world analysis of our neurosurgical resident experience during 56 the peak of the SARS-CoV-2 outbreak in New York City. Understanding volume and case mix 57 of operative and neurointerventional procedures, daily patient census, ICU coverage needs, and 58 rate of resident safety concerns and sick days during this period will aid in understanding 59 resource allocation during future outbreaks. The goal is to provide concrete real-world data that 60 may help other departments prepare their response should they face subsequent second or third 61 waves of the SARS-CoV-2 pandemic. (Table 1 and Table 2 ). Case volume 130 decreased during the system wide peak in COVID-19 hospitalizations, and increased during the The most common categories of operative procedures were spine (18%), neuro-oncology 136 (16.7%), neuro-vascular (13.9%), functional (11.1%), and CSF diversion (11.1%). Most patients 137 were COVID-19 negative (48.6%), confirmed with mean 1.9 swabs. The remainder were 138 unknown (37.5%) and 14% were COVID-19 positive. Eighteen cases (25%) were taken as 139 immediate surgical emergencies; all cases were considered urgent/non-elective.

Most endovascular procedures were interventions (72.5%), with 20.0% thrombectomy for acute 141 stroke, 14.5% lesional subarachnoid hemorrhage, and 7.2% arteriovenous malformation. The majority of endovascular cases were considered immediate procedural emergencies (63.8%).

Most patients were COVID-19 negative (69.6%), confirmed with mean 2.0 swabs.

Hospitalization patterns in the neurosurgical population correlated with system-wide System-wide data on hospital staff infection rates remain preliminary.

As has been described elsewhere, there was an increase in ischemic stroke volume 

COVID-19 and 209 neurosurgical practice: an interim report

MD: Declarations of interest: none Ian T. McNeill, MD: Declarations of interest: none Eric K