Comparison of outcomes of neurosurgical operations performed before and during the COVID-19 pandemic: a matched cohort study

Objective To determine how the first wave of the COVID-19 pandemic
affected outcomes for all operatively managed neurosurgical patients, not
only those positive for SARS-CoV-2. Design Matched cohort (pairwise
method). Setting A single tertiary neurosurgical referral centre at a
large UK Major Trauma Centre. Participants During the first COVID-19 wave,
231 neurosurgical cases were performed. These cases were matched to cases
from 2019. Cases were matched for age (±10 years), primary pathology and
surgical procedure. Cases were excluded from analysis if either the age
could not be matched to within 10 years, or the primary pathology or
procedure was too unique. After exclusions, 191 cases were included in
final analysis Outcome measures Primary outcomes were 30-day mortality and
postoperative pulmonary complications. Secondary outcomes included Glasgow
Outcome Score (GOS) on discharge, length of stay (LoS), operative and
anaesthetic times and grade of primary surgeon. An exploratory outcome was
the SARS-CoV-2 status of patients. Results There was no significant
difference between the pandemic and matched cohorts in 30-day mortality,
pulmonary complications, discharge GOS, LoS, operative or anaesthetic
times. There was a significant difference in the variation of grade of
primary surgeon. Only 2.2% (n=5) of patients had a SARS-CoV-2 positive
swab. Conclusion During the first UK wave of the COVID-19 pandemic, the
mortality, morbidity and functional outcomes of operatively managed
neurosurgical patients at University Hospitals Birmingham were not
significantly affected compared with normal practice. The grade of primary
surgeon was significantly more senior and adds to the growing body of
evidence that demonstrates how the pandemic has negatively impacted UK
surgical training. Mixing COVID-19 positive, unknown and negative cases
did not significantly impact on outcomes and indicates that further
research is required to support the implementation of evidence-based
surgical pathways, such as COVID-light sites, throughout the next stage of
the pandemic.