A systematic review on the impact of the COVID-19 pandemic on neurosurgical practice and Indian Perspective

Saravanan Sadhasivam; Rajnish Arora; Rajasekhar Rekapalli; Jitender Chaturvedi; Nishant Goyal; Pranshu Bhargava; Radhey Mittal

doi:10.4103/ajns.AJNS_379_20

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(01): 24-32
DOI: 10.4103/ajns.AJNS_379_20

Review Article

A systematic review on the impact of the COVID-19 pandemic on neurosurgical practice and Indian Perspective

Authors

Saravanan Sadhasivam

Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
Rajnish Arora

Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
Rajasekhar Rekapalli

Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
Jitender Chaturvedi

Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
Nishant Goyal

Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
Pranshu Bhargava

Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
Radhey Mittal

Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand

Abstract

Objective: The study objective was to systematically review the impact of the current pandemic on neurosurgical practice and to find out a safe way of practicing neurosurgery amid the highly infectious patients with COVID-19. Materials and Methods: A review of the PubMed and EMBASE databases was performed. The literature was systematically searched using keywords such as “COVID-19” and “Neurosurgery.” Results: Among the 425 records, 128 articles were found to be eligible for analysis. These articles described the perspectives of the neurosurgical departments during the pandemic, departmental models, and organizational schemes for triaging emergent and nonemergent neurosurgical cases for the optimal utilization of limited resources, and solutions to continue academic and research activities. Triaging systems help us to optimally utilize the limited resources available. Guidelines have been developed for safe neurosurgical practice and for the continuation of clinical and academic activities during this pandemic by various national and international neurosurgical societies. Key changes in the telemedicine regulatory guidelines would help us to continue to provide neurosurgical care. Videoconferences, online education programs, and webinars could help us to overcome the disadvantages brought upon the neurosurgical education by the social-distancing norms. Conclusion: In an unprecedented time like this, no single algorithm is going to clear the ethical dilemma faced by us. Individual patient triage is a way for maintaining our ethical practice and at the same time, for efficiently utilizing the limited resources. As the pandemic progresses, new guidelines and protocols will continue to evolve for better neurosurgical practice.

Key-words:

COVID-19 - impact - neurosurgery - triage

Full Text

References

References
1 Novel Coronavirus (2019-nCoV) Situation Report-1. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf?sfvrsn=20a99c10_4. [Last accessed on 2020 Jul 10].
2 Coronavirus Disease 2019 (COVID-19) Situation Report –51. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_10. [Last accessed on 2020 Jun 30].
3 Kondziolka D, Couldwell WT, Rutka, JT. Introduction. On pandemics: The impact of COVID-19 on the practice of neurosurgery. J Neurosurg 2020;10:1-2.
4 World Meter: COVID-19 Coronavirus Pandemic. Available from: https://www.worldometers.info/coronavirus/#countries. [Last accessed on 2020 Jul 10].
5 Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and explanation. BMJ 2015;350:g7647.
6 Governor Abbott Issues Executive Order Increasing Hospital Capacity, Announces Supply Chain Strike Force For COVID-19 Response. Available from: https://gov. texas.gov/news/post/governor-abbott-issues-executive-order-increasing-hospital-capa city-announces-supply-chain-strik e-force-for-covid-19-response. [Last accessed on 2020 Jun 10].
7 The Royal College of Surgeons of England. COVID-19: Good Practice for Surgeons and Surgical Teams; 2020. Available from: https://www.rcseng.ac.uk/standards-and-research/standards-and-guidance/good-practice-guides/coronavirus/covid-19-good-practice-for-surgeons-and-surgical-teams/. [Last accessed on 2020 Jun 30].
8 Lee ZD, Chyi Yeu DL, Ang BT, Ng WH, Seow WT. Editorial. COVID-19 and its impact on neurosurgery: Our early experience in Singapore. J Neurosurg 2020;17:1-2.
9 Grasso G, Munakomi S. Neurosurgical practice at the time of COVID-19. World Neurosurg 2020;138:565-6.
10 Jean WC, Ironside NT, Sack KD, Felbaum DR, Syed HR. The impact of COVID-19 on neurosurgeons and the strategy for triaging non-emergent operations: A global neurosurgery study. Acta Neurochir (Wien) 2020;162:1229-40.
11 CMS Adult Elective Surgery and Procedures Recommendations; 2020. Available from: https://www.cms.gov/files/document/cms-non-emergent-elective-medical-recommendationspdf. [Last accessed on 2020 Jun 13].
12 The American College of Surgeons (ACS). COVID-19: Guidance for Triage of Non-Emergent Surgical Procedures; 2020. Available from: https://www.facs.org/covid-19/clinical-guidance/triage. [Last accessed on 2020 Jun 13].
13 Agosti E, Giorgianni A, Pradella R, Locatelli D. Coronavirus disease 2019 (COVID-19) outbreak: Single-center experience in neurosurgical and neuroradiologic emergency network tailoring. World Neurosurg 2020;138:548-50.
14 Burke JF, Chan AK, Mummaneni V, Chou D, Lobo EP, Berger MS, et al. Letter: The Coronavirus Disease 2019 Global Pandemic: A Neurosurgical Treatment Algorithm. Neurosurgery 2020;87:E50-6.
15 Arnaout O, Patel A, Carter B, Chiocca EA. Letter: Adaptation under fire: Two Harvard neurosurgical services during the COVID-19 pandemic. Neurosurgery 2020;87:E173-7.
16 Zacharia BE, Eichberg DG, Ivan ME, Hanft S, Boockvar JA, Isildak H, et al. Letter: Surgical management of brain tumor patients in the COVID-19 Era. Neurosurgery 2020;87:E197-200.
17 Gupta P, Muthukumar N, Rajshekhar V, Tripathi M, Thomas S, Gupta SK, et al. Neurosurgery and neurology practices during the novel COVID-19 pandemic: A consensus statement from India. Neurol India 2020;68:246-54.
18 Mohile NA, Blakeley JO, Gatson NTN, Hottinger AF, Lassman AB, Ney DE, et al. Urgent considerations for the neuro-oncologic treatment of patients with gliomas during the COVID-19 pandemic. Neuro Oncol 2020;22:912-17.
19 Ramakrishna R, Zadeh G, Sheehan JP, Aghi MK. Inpatient and outpatient case prioritization for patients with neuro-oncologic disease amid the COVID-19 pandemic: General guidance for neuro-oncology practitioners from the AANS/CNS Tumor Section and Society for Neuro-Oncology. J Neurooncol 2020;147:525-9.
20 Giorgi PD, Villa F, Gallazzi E, Debernardi A, Schirò GR, Crisà FM, et al. The management of emergency spinal surgery during the COVID-19 pandemic in Italy. Bone Joint J 2020;102-B: 671-6.
21 Muhammad S, Tanikawa R, Lawton MT, Niemelä M, Hänggi D. Letter: Safety Instructions for Neurosurgeons During COVID-19 Pandemic Based on Recent Knowledge and Experience. Neurosurgery 2020;87:E220-E221. doi:10.1093/neuros/nyaa184.
22 van Doremalen N, Morris DH, Holbrook MG, Gamble A, Williamson BN. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med 2020;382:1965-6.
23 Workman AD, Welling DB, Carter BS, Curry WT, Holbrook EH, Gray ST, et al. Endonasal instrumentation and aerosolization risk in the era of COVID-19: Simulation, literature review, and proposed mitigation strategies. Int Forum Allergy Rhinol 2020;10:798-805.
24 American Academy of Otolaryngology Head and Neck Surgery. Academy Supports CMS, Offers Specific Nasal Policy; 2020. Available from: https://www.entnet.org/content/academy-supports-cms-offers-specific-nasalpolicy. [Last accessed on 2020 Jun 13].
25 Patel ZM, Fernandez-Miranda J, Hwang PH, Nayak JV, Dodd R, Sajjadi H, et al. Letter: Precautions for endoscopic transnasal skull base surgery during the COVID-19 pandemic. Neurosurgery 2020;87:E66-7.
26 Castelnuovo P, Turri-Zanoni M, Karligkiotis A, Battaglia P, Pozzi F, Locatelli D, et al. Skull base surgery during the Covid-19 pandemic: The Italian skull base society recommendations. Int Forum Allergy Rhinol 2020;10:963-7.
27 Kolias A, Tysome J, Donnelly N, Sharma R, Gkrania-Klotsas E, Budohoski K, et al. A safe approach to surgery for pituitary and skull base lesions during the COVID-19 pandemic. Acta Neurochir (Wien) 2020;162:1509-11.
28 Greven AC, Rich CW, Malcolm JG, Bray DP, Rodts GE, Refai D, et al. Letter: Neurosurgical management of spinal pathology via telemedicine during the COVID-19 pandemic: Early experience and unique challenges. Neurosurgery 2020;87:E192-6.
29 Carter BS, Chiocca EA. Editorial. COVID-19 and academic neurosurgery [published online ahead of print, 2020 Apr 17]. J Neurosurg. 2020;1-2. doi:10.3171/2020.4.JNS201013.
30 Clark VE. Editorial. Impact of COVID-19 on neurosurgery resident research training. J Neurosurg 2020;133:12-13. doi:10.3171/2020.4.JNS201034.
31 Lewis CT, Zeineddine HA, Esquenazi Y. Challenges of neurosurgery education during the coronavirus disease 2019 (COVID-19) pandemic: A U.S. perspective. World Neurosurg 2020;138:545-7.
32 Centers for Disease Control and Prevention. Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance). Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-n-hospitalized-patients.html. [Last accessed on 2020 Jun 13].
33 Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.
34 Gao Z, Xu Y, Sun C, et al. A Systematic Review of Asymptomatic Infections with COVID-19 [published online ahead of print, 2020 May 15]. J Microbiol Immunol Infect. 2020;10.1016/j.jmii.2020.05.001. doi:10.1016/j.jmii.2020.05.001.
35 Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA 2020;323:1843-4.
36 The American Society of Anesthesiologists (ASA) and Anesthesia Patient Safety Foundation (APSF) Joint Statement on Perioperative Testing for the COVID-19 Virus; 2020. Available from: https://www.asahq.org/about-asa/newsroom/news-releases/2020/06/asa-and-apsf-joint-statement-on-perioperative-testing-for-the-covid-19-virus. [Last accessed on 2020 Jun 10].
37 Intercollegiate Guidelines for Preoperative COVID-19 Testing for Elective Cancer Surgery Update; 2020. Available from: https://www.rcsed.ac.uk/news-public-affairs/news/2020/may/intercollegiate-guidelines-for-pre- operative-covid-19-testing-for-ele ctive-cancer-surgery-update. [Last accessed on 2020 Jun 10].
38 Chan DY, Chan DT, Mak WK, Wong GK, Poon WS. Letter: Rongeurs, neurosurgeons, and COVID-19: How do we protect health care personnel during neurosurgical operations in the midst of aerosol-generation from high-speed drills? Neurosurgery 2020;87:E164-5.
39 Chellaiyan VG, Nirupama AY, Taneja N. Telemedicine in India: Where do we stand? J Family Med Prim Care 2019;8:1872-6.
40 Telemedicine Practice Guidelines by Government of India; 2020. Available from: https://www.mohfw.gov.in/pdf/Telemedicine.pdf. [Last accessed on 2020 Jun 10].
41 Bray DP, Stricsek GP, Malcolm J, Gutierrez J, Greven A, Barrow DL, et al. Letter: Maintaining neurosurgical resident education and safety during the COVID-19 pandemic. Neurosurgery 2020;87:E189-91.
42 Downes SR, Lykina T. Closing the gap in global neurosurgical education via online conference: A pre-COVID survey. Cureus 2020;12:e8015.
43 Eichberg DG, Shah AH, Luther EM, Menendez I, Jimenez A, Perez-Dickens M, et al. Letter: Academic neurosurgery department response to COVID-19 pandemic: The University of Miami/Jackson Memorial Hospital Model. Neurosurgery 2020;87:E63-5.
44 Congress of Neurological Surgeons. Complimentary Online Education. Available from: https://www.cns.org/onlineed. [Last accessed on 2020 May 30].
45 Tomlinson SB, Hendricks BK, Cohen-Gadol AA. Editorial. Innovations in neurosurgical education during the COVID-19 pandemic: is it time to reexamine our neurosurgical training models? [published online ahead of print, 2020 Apr 17] J Neurosurg. 2020;1-2. doi:10.3171/2020.4.JNS201012.
46 Hulsbergen AF, Eijkholt MM, Balak N, Brennum J, Bolger C, Bohrer AM, et al. Ethical triage during the COVID-19 pandemic: A toolkit for neurosurgical resource allocation. Acta Neurochir (Wien) 2020;162:1485-90.
47 Am. Coll. Surg Joint statement, 2020: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic. Available from: https://www.asahq.org/about-asa/newsroomnews-releases/2020/04/joint-statement-on-elective-surgery-after-covid-19-pandemic. [Last accessed on 2020 Jun 10].
48 D'Amico RS, Baum G, Serulle Y, Silva D, Smith ML, Wallack RA, et al. A roadmap to reopening a neurosurgical practice in the age of COVID-19. World Neurosurg 2020;139:289-93.