RESUMO
BACKGROUND: Cancellation of elective operations during the COVID-19 pandemic has led to a significant increase in the number of patients waiting for treatment. In neurosurgery, treatment for spinal diseases, in particular, has been disproportionately delayed. We aim to describe the waiting list burden at our institution and forecast the time and theatre capacity required to return to pre-pandemic levels. METHODS: A retrospective evaluation of the waiting list records (both cranial and spinal), from January 2015-October 2022, inclusive, was conducted at a high-volume neurosciences centre. The average monthly decrease in the waiting list was calculated for the months since the waiting list was noted to fall consistently during or after the pandemic, as applicable. Five different scenarios were modelled to identify the time required to reduce the waiting list to the pre-pandemic level of December 2019. Data collection and analyses were performed on Excel (Microsoft). RESULTS: At the pre-pandemic threshold (December 2019), 782 patients were on the waiting list. Between January 2015-January 2020, inclusive, an average of 673 patients were on the waiting list but this has doubled over the subsequent months to a peak of 1388 patients in December 2021. Between December 2021-October 2022, on average, the waiting list reduced by 18 per month. At the current rate of change, the waiting list would fall to the pre-pandemic level by October 2024, an interval of 24 months. A seven-day service would require 18 months to clear the backlog. Doubling or tripling the current rate of change would require 12 months and 8 months, respectively. CONCLUSIONS: Pre-existing, pandemic-related, and new NHS-wide challenges continue to have negative influences on reducing the backlog. Proposals for surgical hubs to tackle this carry the risks of removing staff from hospitals which cannot avoid emergency/urgent operating thereby further reducing those institutions' capacity to undertake elective work.
RESUMO
BACKGROUND: Coronavirus disease 2019 (COVID-19) is a severe respiratory viral illness that has spread rapidly across the world. However, the United Kingdom has been particularly affected. Evidence has suggested that stroke, cardiac, and spinal presentations decreased during the pandemic as the public avoided seeking care. The effect on neurosurgical presentations and referrals during COVID-19 is unclear. Our aim, therefore, was to describe the referral patterns to a high-volume neurosurgical department in the United Kingdom during the COVID-19 pandemic. METHODS: Electronic referrals were identified from the referrals database from January 1, 2020 to May 31, 2020, inclusive, with January used as the baseline. The demographic data and referral diagnoses were captured on Excel (Microsoft, Redmond, Washington, USA). Statistical analyses were performed using SPSS, version 22 (IBM Corp., Armonk, New York, USA). Differences between referral volumes were evaluated using χ2 goodness-of-fit tests. RESULTS: A total of 2293 electronic referrals had been received during the study period. The median age was 63 years. Overall, the referrals had decreased significantly in volume during the study period [χ2(4) = 60.95; P < 0.001]. We have described the patterns in the daily referrals as the pandemic progressed. The reduction in the volume of referrals for degenerative spine cases and traumatic brain injuries was statistically significant (P < 0.001). CONCLUSIONS: The referrals for degenerative spine and traumatic brain injuries decreased significantly during the pandemic, which can be explained by the lower vehicular traffic and patient avoidance of healthcare services, respectively. The risk of neurological deterioration and increased morbidity and mortality, as a consequence, is of concern, and neurosurgeons worldwide should consider the optimal strategies to mitigate these risks as the pandemic eases.