• Khalid Bajunaid, Abdullah Alatar, Ashwag Alqurashi, Mohammad Alkutbi, Anas H Alzahrani, Abdulrahman J Sabbagh, Abdullah Alobaid, Abdulwahed Barnawi, Ahmed A Alferayan, Ahmed M Alkhani, Bin Salamah Ali A Department of Neurosurgery, King Saud Medical City, Riyadh, Saudi Arabia., Bassem Y Sheikh, Fahad E Alotaibi, Faisal Alabbas, Faisal Farrash, Hosam M Al-Jehani, Husam Alhabib, Ibrahim Alnaami, Ikhlass Altweijri, Isam Khoja, Mahmoud Taha, Moajeb Alzahrani, Mohammed S Bafaquh, Mohammed Binmahfoodh, Mubarak A Algahtany, Sabah Al-Rashed, Syed M Raza, Sherif Elwatidy, Soha A Alomar, Wisam Al-Issawi, Yahya H Khormi, Ahmad Ammar, Amro Al-Habib, Saleh S Baeesa, and Abdulrazag Ajlan.
• Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia; Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
• Clin Neurol Neurosurg. 2020 Nov 1; 198: 106237.

ObjectiveThis observational cross-sectional multicenter study aimed to evaluate the longitudinal impact of the coronavirus disease 2019 (COVID-19) pandemic on neurosurgical practice.MethodsWe included 29 participating neurosurgeons in centers from all geographical regions in the Kingdom of Saudi Arabia. The study period, which was between March 5, 2020 and May 20, 2020, was divided into three equal periods to determine the longitudinal effect of COVID-19 measures on neurosurgical practice over time.ResultsDuring the 11-week study period, 474 neurosurgical interventions were performed. The median number of neurosurgical procedures per day was 5.5 (interquartile range [IQR]: 3.5-8). The number of cases declined from 72 in the first week and plateaued at the 30's range in subsequent weeks. The most and least number of performed procedures were oncology (129 [27.2 %]) and functional procedures (6 [1.3 %]), respectively. Emergency (Priority 1) cases were more frequent than non-urgent (Priority 4) cases (178 [37.6 %] vs. 74 [15.6 %], respectively). In our series, there were three positive COVID-19 cases. There was a significant among-period difference in the length of hospital stay, which dropped from a median stay of 7 days (IQR: 4-18) to 6 (IQR: 3-13) to 5 days (IQR: 2-8). There was no significant among-period difference with respect to institution type, complications, or mortality.ConclusionOur study demonstrated that the COVID-19 pandemic decreased the number of procedures performed in neurosurgery practice. The load of emergency neurosurgery procedures did not change throughout the three periods, which reflects the need to designate ample resources to cover emergencies. Notably, with strict screening for COVID -19 infections, neurosurgical procedures could be safely performed during the early pandemic phase. We recommend to restart performing neurosurgical procedures once the pandemic gets stabilized to avoid possible post pandemic health-care system intolerable overload.Copyright © 2020 Elsevier B.V. All rights reserved.

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