• Dimitri Benner, Benjamin K Hendricks, Cyrus Elahi, Michael D White, Gary Kocharian, Leonardo E Albertini Sanchez, Kyle E Zappi, GartonAndrew L AALADepartment of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA., Joseph A Carnevale, Theodore H Schwartz, Ehsan Dowlati, Daniel R Felbaum, Kenneth D Sack, Walter C Jean, Andrew K Chan, John F Burke, Praveen V Mummaneni, Michael J Strong, Timothy J Yee, Mark E Oppenlander, Mariam Ishaque, Mark E Shaffrey, Hasan R Syed, and Michael T Lawton.
• Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
• World Neurosurg. 2022 Sep 1; 165: e242e250e242-e250.

ObjectiveChanges to neurosurgical practices during the coronavirus disease 2019 (COVID-19) pandemic have not been thoroughly analyzed. We report the effects of operative restrictions imposed under variable local COVID-19 infection rates and health care policies using a retrospective multicenter cohort study and highlight shifts in operative volumes and subspecialty practice.MethodsSeven academic neurosurgery departments' neurosurgical case logs were collected; procedures in April 2020 (COVID-19 surge) and April 2019 (historical control) were analyzed overall and by 6 subspecialties. Patient acuity, surgical scheduling policies, and local surge levels were assessed.ResultsOperative volume during the COVID-19 surge decreased 58.5% from the previous year (602 vs. 1449, P = 0.001). COVID-19 infection rates within departments' counties correlated with decreased operative volume (r = 0.695, P = 0.04) and increased patient categorical acuity (P = 0.001). Spine procedure volume decreased by 63.9% (220 vs. 609, P = 0.002), for a significantly smaller proportion of overall practice during the COVID-19 surge (36.5%) versus the control period (42.0%) (P = 0.02). Vascular volume decreased by 39.5% (72 vs. 119, P = 0.01) but increased as a percentage of caseload (8.2% in 2019 vs. 12.0% in 2020, P = 0.04). Neuro-oncology procedure volume decreased by 45.5% (174 vs. 318, P = 0.04) but maintained a consistent proportion of all neurosurgeries (28.9% in 2020 vs. 21.9% in 2019, P = 0.09). Functional neurosurgery volume, which declined by 81.4% (41 vs. 220, P = 0.008), represented only 6.8% of cases during the pandemic versus 15.2% in 2019 (P = 0.02).ConclusionsOperative restrictions during the COVID-19 surge led to distinct shifts in neurosurgical practice, and local infective burden played a significant role in operative volume and patient acuity.Copyright © 2022 Elsevier Inc. All rights reserved.

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