Demand for essential non-ambulatory neurosurgical care decreased while acuity of care increased during the COVID surge.

Abstract

BACKGROUND\nIn times of health resource reallocation, capacities must remain able to meet a continued demand for essential, non-ambulatory neurosurgical acute care. This study sought to characterize the demand for and provision of neurosurgical acute care during the COVID-19 pandemic.\n\n\nMETHODS\nThis single-center cross-sectional observational analysis compared nonambulatory neurosurgical consult encounters during the peri-surge period (3/9-5/31/2020) with those during an analogous period in 2019. Outcomes included consult volume, distribution of problem types, disease severity, and rate of acute operative intervention.\n\n\nRESULTS\nA total of 1,494 neurosurgical consults were analyzed. Amidst the pandemic surge, 583 consults were seen, which was 6.4 standard deviations below the mean among analogous 2016-2019 periods (mean=873; SD=45, p=0.001). Between 2019 and 2020, the proportion of degenerative spine consults decreased in favor of spinal trauma (25.6% vs 34% and 51.9% vs 41.4%, p=0.088). Among aneurysmal subarachnoid hemorrhage cases, poor-grade (HH4-5) presentations were more common (30% vs 14.8%, p=0.086). A higher proportion of pandemic era consults resulted in acute operative management, with an unchanged absolute frequency of acutely operative consults (123/583 (21.1%) vs 120/911 (13.2%), p<0.001).\n\n\nCONCLUSIONS\nNeurosurgical consult volume during the pandemic surge hit a 5-year institutional low. Amidst vast reallocation of healthcare resources, demand for high-acuity non-ambulatory neurosurgical care continued, and proportionally increased for higher-acuity pathologies. In our continued current pandemic as well as any future situations of mass health resource reallocation, neurosurgical acute care capacities must be preserved.