Background
Methods
Survey
Questionnaire data
Data analysis
Results
Respondent characteristics and current COVID-19 status
Variable | Number of hospitals (%) |
---|---|
Responding neurosurgeon’s specialty | |
Cerebrovascular | 9 (6.3) |
General | 28 (19.5) |
Functional | 5 (3.5) |
Multi-specialty | 20 (13.9) |
Neuro-oncology | 75 (52.1) |
Pediatric | 3 (2.1) |
Skull base | 1 (0.7) |
Spine | 3 (2.1) |
First diagnosis of COVID-19 in respondents’ region | |
December, 2019 | 8 (5.6) |
January, 2020 | 97 (67.4) |
February, 2020 | 33 (22.9) |
March, 2020 | 4 (2.8) |
Current number of COVID-19 cases in respondents’ region | |
< 100 | 5 (3.5%) |
101–500 | 1 (0.7%) |
501–1000 | 3 (2.1%) |
> 1000 | 135 (93.8%) |
Current number of COVID-19-related deaths in respondents’ region | |
< 100 | 0 (0%) |
101–500 | 13 (9%) |
501–1000 | 0 (%) |
> 1000 | 137 (91%) |
Public health restrictions in place | 144 (100%) |
Nature of public health restrictions | |
Restrictions on public gatherings of > 100 people | 1 (0.7) |
Restrictions on public gatherings of > 10 people | 7 (4.9) |
Restrictions on all public gatherings of any size | 81 (56.3) |
Complete curfew/blockade, closed nonessential services | 54 (37.5) |
Hospital is a COVID-19 dedicated hospital | 73 (50.7) |
COVID-19 patients have been hospitalized at hospital | 95 (66.0) |
Number of COVID-19-related hospitalizations at hospital | |
< 10 | 97 (67.4) |
11–50 | 26 (18.1) |
51–100 | 6 (4.2) |
> 100 | 15 (10.4) |
Percentage of COVID-19-patients by hospital capacity | |
< 10% | 130 (95.0) |
10–50% | 6 (4.3) |
> 50% | 1 (0.7) |
Impact of COVID-19 pandemic on neurosurgery activity
Variable | Number of hospitals (%) |
---|---|
Annual neurosurgery volume (median [IQR]) | 400 [350; 700] |
Number of neurosurgery beds (median [IQR]) | 63 [45; 116] |
Reduction in neurosurgery case volume due to COVID-19 | |
< 25% | 20 (13.9) |
26–50% | 56 (38.9) |
51–75% | 42 (29.2) |
76–100% | 26 (18.1) |
Reduction in number of dedicated neurosurgery ORs | |
Little to no reduction | 66 (45.8) |
Small reduction (< 1/3 of neurosurgery ORs) | 6 (4.2) |
Moderate reduction (< 2/3 of neurosurgery ORs) | 13 (9.0) |
Major reduction (≥ 2/3 of neurosurgery ORs) | 19 (13.2) |
No dedicated ORs (100% reduction of neurosurgery ORs) | 9 (6.3) |
Reduction in number of neurosurgery ICU beds | |
Little to no reduction | 93 (64.6) |
Small reduction (< 1/3 of total ICU beds) | 8 (5.6) |
Moderate reduction (< 2/3 of total ICU beds) | 11 (7.6) |
Major reduction (≥ 2/3 of total ICU beds) | 15 (10.4) |
No dedicated ICU beds (100% reduction of ICU beds) | 9 (6.3) |
Current number of ventilators (median [IQR]) | 9 [4; 20] |
Number of hospitals with increased ventilators | 42 (29.2) |
Percentage increase in number of ventilators (median) | 0.5% |
Level of personal protection by neurosurgeons operating on COVID-19-negative patients | |
Routine gowning | 73 (50.7) |
Routine gowning with N95 mask | 35 (24.3) |
Gowns with junctions sealed, with air supply or self-contained breathing apparatus | 21 (14.6) |
Completely enclosed gowns with self-contained breathing apparatus | 15 (10.4) |
Scheduled neurosurgeries still being performed as planned on COVID-19 positive patients | 34 (23.4) |
At the peak of the pandemic, was there shortage of COVID-19 related supplies/PPE in the hospital? | |
Little or no disruption | 40 (27.8) |
Moderate disruption | 71 (49.3) |
Severe disruption | 20 (13.9) |
Level of personal protection by neurosurgeons operating on COVID-19-positive patients | |
Routine gowning | 14 (9.7) |
Routine gowning with N95 mask | 17 (11.8) |
Gowns with junctions sealed, with air supply or self-contained breathing apparatus | 11 (7.6) |
Completely enclosed gowns with self-contained breathing apparatus | 101 (70.1) |
Changes to pre-operative COVID-19 screening guidelines for CNS tumor patients | 120 (83.3) |
If yes, what changes? | |
Confirmation of COVID-19 status by laboratory test as negative | 58 (48.4) |
Screening for COVID-19 based on history, clinical manifestation, and imaging | 62 (51.6) |
Suspension of post-operative adjuvant therapy | 52 (36.1) |
If no, what measures have been taken to administer post-operative adjuvant therapy? | |
Home-based assisted treatment | 4 (2.8) |
Strict isolation, single room treatment | 14 (9.7) |
Intensive screening for COVID-19 | 29 (20.1) |
Improving the protection level of doctors and patients | 12 (8.3) |
Referral to other hospitals | 35 (24.3) |
Staff training to operate ventilators? | 93 (64.6) |
Number of neurosurgeons/fellows per hospital (median [IQR]) | 16 (9; 30) |
Personnel relocation from neurosurgery to other departments | 91 (63.2) |
Relocation of: | |
Neurosurgeons | 68 (47.2) |
Operating room nurses/technicians | 35 (24.3) |
Trainees | 75 (52.1) |
ICU nurses | 91 (63.2) |
Floor nurses | 91 (63.2) |
Routine continuation of research | 21 (14.6) |
Suspension of research | 85 (59.0) |
Modifications of research | 31 (21.5) |
Research personnel working from home | 14 (9.7) |
Clinical research continuing but basic science research suspended | 3 (2.1) |
Segregation of research personnel | 14 (9.7) |
Trainees permitted to perform cases | 67 (46.5) |
Trainees required to stay at home unless on call or critically needed | 78 (54.2) |
Medical students mandated to stay at home | 104 (72.2) |
Impact of COVID-19 pandemic on neuro-oncological surgery personnel
Impact of COVID-19 pandemic on neurosurgery education and research
Impact of COVID-19 pandemic on hospital policies
Variable | Number of hospitals (%) |
---|---|
Criteria for performing neurosurgery | |
Only emergency surgery in COVID-19-negative patients (diagnosed by imaging and laboratory examination) | 5 (3.5) |
Only emergency surgery in COVID-19-negative patients (diagnosed by clinical manifestation and imaging) | 2 (1.4) |
Only emergency surgery (regardless of COVID-19 status) | 16 (11.1) |
Neurosurgery in only COVID-19-negative patients (diagnosed by imaging and laboratory examination) | 44 (30.6) |
Neurosurgery in only COVID-19-negative patients (diagnosed by clinical manifestation and imaging) | 53 (36.8) |
Other criteria | 15 (10.4) |
Emergency neurosurgery status | |
No emergency surgery | 9 (6.3) |
Only for COVID-negative patients | 52 (36.1) |
Emergency surgery performed routinely | 83 (57.6) |
Elective neuro-oncological surgery status | |
No elective surgery | 52 (36.1) |
Only for COVID-negative patients | 74 (51.4) |
Elective surgery performed routinely | 18 (12.5) |
Protocols to restrict visitors to neurosurgery department | 141 (97.9) |
Discussion of ethical issues concerning how decisions will be made in the event healthcare resources must be prioritized and allocated | 122 (84.7) |
Patient follow-up for discharged patients | |
In-person | 10 (6.9) |
Telehealth | 27 (18.8) |
Phone call | 107 (74.3) |
Mobile nurses | 0 (0%) |
Anticipation that the current COVID-19 pandemic will be contained in the upcoming weeks | 124 (86.1) |
Assessment of how soon operating restrictions might be lifted | |
< 1 month | 36 (25.0) |
1–3 months | 100 (69.4) |
3–6 months | 3 (2.1) |
> 6 months | 1 (0.7) |
Anticipation of COVID-19-related disruption to neurosurgery department supplies | |
Little or no disruption | 61 (42.4) |
Moderate disruption | 70 (48.6) |
Severe disruption | 13 (9.0) |
Anticipation of further COVID-19-related re-allocation of personnel from neurosurgery department | |
Little or none | 116 (80.6) |
Moderate | 26 (18.1) |
Extensive | 2 (1.4) |