HumanInsight The Effect of the COVID-19 Pandemic on Elective Cervical Spine Surgery Utilization and Complications in the United States: A Nationwide Temporal Trends Analysis
World Neurosurg. 2022 Jul 30:S1878-8750(22)01044-0. doi: 10.1016/j.wneu.2022.07.095. Online ahead of print.
OBJECTIVES: As a result of the COVID-19 pandemic, elective surgeries nationwide were suspended. The objective is to compare temporal trends in patient demographics, case volumes, and postoperative complications of patients undergoing elective cervical spine surgery from pre-COVID (2019-2020Q1) to post-COVID (2020Q2-Q4).
METHODS: The 2019 to 2020 ACS-NSQIP database was queried for common elective cervical spine surgeries. Patients pre-COVID (2019-2020Q1) were compared with those undergoing surgery during post-COVID (2020Q2-Q4) protocols. Procedural utilization, patient demographics, and complications were compared. Linear regression was used to evaluate case volume changes over time. P values less than 0.05 were significant.
RESULTS: In total, 31,013 patients underwent elective cervical spine surgery in 2019 (N= 16,316) and 2020 (N=14,697); an overall 10% decline. Compared to the calendar year 2019 through 2020Q1 mean, elective surgery volume decreased by 21.6% in 2020Q2 and never returned to pre-pandemic baseline. The percentage decline in case volume from 2019-2020Q1 to 2020Q2 was greatest for ACDF (23.3%), followed by cervical decompression (23.4%), posterior cervical fusion (15.0%), and cervical disc arthroplasty and vertebral corpectomy (13.7%). Patients undergoing surgery in 2020Q2-Q4 had overall higher comorbidity burden (ASA Class 3 and 4) (p<0.001). From 2019-2020Q1 versus 2020Q2-Q4, there was a significant increase in total complication (5.5% vs 6.8%, p<0.001), reoperation (1.9% vs 2.2%, p=0.048), and mortality (0.25% vs 0.37%, p=0.049) rates.
CONCLUSION: Elective surgery declined drastically during the second quarter of 2020. Patients undergoing surgery during the pandemic had an overall higher comorbidity burden, resulting in increased total complication and mortality rates over the study period.
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