The world currently faces the novel severe acute respiratory syndrome coronavirus 2 pandemic. Little is known about the effects of a pandemic on non-elective neurosurgical practices, which have continued under modified conditions to reduce the spread of COVID-19. This knowledge might be critical for the ongoing second coronavirus wave and potential restrictions on health care. We aimed to determine the incidence and 30-day mortality rate of various non-elective neurosurgical procedures during the COVID-19 pandemic. A retrospective, multi-centre observational cohort study among neurosurgical centres within Austria, the Czech Republic, and Switzerland was performed. Incidence of neurosurgical emergencies and related 30-day mortality rates were determined for a period reflecting the peak pandemic of the first wave in all participating countries (i.e. March 16th-April 15th, 2020), and compared to the same period in prior years (2017, 2018, and 2019). A total of 4,752 emergency neurosurgical cases were reviewed over a 4-year period. In 2020, during the COVID-19 pandemic, there was a general decline in the incidence of non-elective neurosurgical cases, which was driven by a reduced number of traumatic brain injuries, spine conditions, and chronic subdural hematomas. Thirty-day mortality did not significantly increase overall or for any of the conditions examined during the peak of the pandemic. The neurosurgical community in these three European countries observed a decrease in the incidence of some neurosurgical emergencies with 30-day mortality rates comparable to previous years (2017-2019). Lower incidence of neurosurgical cases is likely related to restrictions placed on mobility within countries, but may also involve delayed patient presentation.

Clinic of Neurosurgery Neurocenter of Southern Switzerland Lugano Switzerland

Department of Neurosurgery and Neuro Oncology 1St Medical Faculty Charles University Central Military Hospital Prague Czech Republic

Department of Neurosurgery and Neurorestauration Klinikum Klagenfurt Klagenfurt Austria

Department of Neurosurgery Ceske Budejovice Hospital Ceske Budejovice Czech Republic

Department of Neurosurgery Christian Doppler Clinic Paracelsus Medical University Salzburg Austria

Department of Neurosurgery Clinical Neuroscience Center University Hospital Zurich Zurich Switzerland

Department of Neurosurgery General Hospital Wiener Neustadt Wiener Neustadt Austria

Department of Neurosurgery Geneva University Hospitals Geneva Switzerland

Department of Neurosurgery Inselspital Bern Bern University Hospital Bern Switzerland

Department of Neurosurgery Kantonspital Aarau Aarau Switzerland

Department of Neurosurgery Kantonspital St Gallen St Gallen Switzerland

Department of Neurosurgery Kepler University Hospital GmbH Johannes Kepler University Linz Austria

Department of Neurosurgery Klinik Donaustadt Vienna Austria

Department of Neurosurgery Landeskrankenhaus Feldkirch Feldkirch Austria

Department of Neurosurgery Liberec Hospital Prague Czech Republic

Department of Neurosurgery Medical University Graz Graz Austria

Department of Neurosurgery Medical University Innsbruck Anichstrasse 35 MZA 3rd floor 6020 Innsbruck Austria

Department of Neurosurgery Medical University of Vienna Vienna Austria

Department of Neurosurgery Motol University Hospital Motol Czech Republic

Department of Neurosurgery Pilsen University Hospital Pilsen Czech Republic

Department of Neurosurgery St Anne's University Hospital Brno and Masaryk University Prague Czech Republic

Department of Neurosurgery University Hospital Brno and Masaryk University Prague Czech Republic

Department of Neurosurgery University Hospital Hradec Kralove Hradec Kralove Czech Republic

Department of Neurosurgery University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Neurosurgery University Hospital of St Karl Landsteiner University of Health Sciences St Poelten Austria

Department of Neurosurgery University Hospital Olomouc Olomouc Czech Republic

Department of Neurosurgery University Hospital Ostrava Ostrava Czech Republic

Department of Neurosurgery Usti Nad Labem Hospital Prague Czech Republic

International Collaboration On Repair Discoveries University of British Columbia Vancouver BC Canada

Unit of Neurosurgery Homolka Hospital Prague Czech Republic

Unit of Neurosurgery Municipal Hospital Ostrava Fifejdy Ostrava Fifejdy Czech Republic

Unit of Neurosurgery Pardubice Hospital Prague Czech Republic

Unit of Neurosurgery Zlin Hospital Prague Czech Republic

See more in PubMed

Jindal V, Sahu KK, Gaikazian S, Siddiqui AD, Jaiyesimi I. Cancer treatment during COVID-19 pandemic. Med. Oncol. 2020;37:58. doi: 10.1007/s12032-020-01382-w. PubMed DOI PMC

Subramaniam A, Haji JY, Kumar P, Ramanathan K, Rajamani A. Noninvasive oxygen strategies to manage confirmed COVID-19 Patients in Indian intensive care units: a survey. Indian J. Crit. Care Med. 2020;24:926–931. doi: 10.5005/jp-journals-10071-23640. PubMed DOI PMC

Livingston EH. Surgery in a time of uncertainty: a need for universal respiratory precautions in the operating room. JAMA J. Am. Med. Assoc. 2020 doi: 10.1001/jama.2020.7903. PubMed DOI

Iacobucci G. Covid-19: all non-urgent elective surgery is suspended for at least three months in England. BMJ. 2020;368:m1106. doi: 10.1136/bmj.m1106. PubMed DOI

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. 2020;162:1229–1240. doi: 10.1007/s00701-020-04342-5. PubMed DOI PMC

Placella G, Salvato D, Delmastro E, Bettinelli G, Salini V. CoViD-19 and ortho and trauma surgery: the Italian experience. Injury. 2020 doi: 10.1016/j.injury.2020.04.012. PubMed DOI PMC

Arnaout O, Patel A, Carter B, Chiocca EA. Letter: adaptation under fire: two harvard neurosurgical services during the COVID-19 pandemic. Neurosurgery. 2020 doi: 10.1093/neuros/nyaa146. PubMed DOI PMC

Tsermoulas G, Zisakis A, Flint G, Belli A. Challenges to neurosurgery during the coronavirus disease 2019 (COVID-19) pandemic. World Neurosurg. 2020;139:519–525. doi: 10.1016/j.wneu.2020.05.108. PubMed DOI PMC

Bryan AF, Milner R, Roggin KK, Angelos P, Matthews JB. Unknown unknowns: surgical consent during the COVID-19 pandemic. Ann. Surg. 2020 doi: 10.1097/SLA.0000000000003995. PubMed DOI PMC

Service, B. C. et al. Medically Necessary Orthopaedic Surgery During the COVID-19 Pandemic: Safe Surgical Practices and a Classification to Guide Treatment. J. Bone Joint Surg. 10.2106/JBJS.20.00599 (2020). PubMed

Ross, S. W. et al. Maximizing the calm before the storm: tiered surgical response plan for novel coronavirus (COVID-19). J. Am. Coll. Surg.230, 1080 10.1016/j.jamcollsurg.2020.03.019 (2020). PubMed PMC

Zoia C, et al. Neurosurgery during the COVID-19 pandemic: update from Lombardy, northern Italy. Acta Neurochir. 2020;162:1221–1222. doi: 10.1007/s00701-020-04305-w. PubMed DOI PMC

Germano A, Raffa G, Angileri FF, Cardali SM, Tomasello F. Coronavirus disease (COVID-19) and Neurosurgery: literature and Neurosurgical Societies Recommendations Update. World Neurosurg. 2020 doi: 10.1016/j.wneu.2020.04.181. PubMed DOI PMC

Collaborative CO. Global guidance for surgical care during the COVID-19 pandemic. Br. J. Surg. 2020 doi: 10.1002/bjs.11646. PubMed DOI PMC

Jarman MP, et al. The surgical health services research agenda for the COVID-19 pandemic. Ann. Surg. 2020 doi: 10.1097/SLA.0000000000004126. PubMed DOI PMC

Muhammad S, Tanikawa R, Lawton MT, Niemela M, Hanggi 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. PubMed DOI PMC

Lei, S. et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine, 100331, doi:10.1016/j.eclinm.2020.100331 (2020). PubMed PMC

Aminian A, Safari S, Razeghian-Jahromi A, Ghorbani M, Delaney CP. COVID-19 outbreak and surgical practice: unexpected fatality in perioperative period. Ann. Surg. 2020 doi: 10.1097/SLA.0000000000003925. PubMed DOI PMC

Carrabba G, Tariciotti L, Guez S, Calderini E, Locatelli M. Neurosurgery in an infant with COVID-19. Lancet. 2020;395:e76. doi: 10.1016/S0140-6736(20)30927-2. PubMed DOI PMC

Chen, R. et al. Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients. Can. J. Anaesthesia 67, 655–663, 10.1007/s12630-020-01630-7 (2020). PubMed PMC

Panciani PP, et al. Letter: COVID-19 infection affects surgical outcome of chronic subdural hematoma. Neurosurgery. 2020 doi: 10.1093/neuros/nyaa140. PubMed DOI PMC

Zhong Q, et al. Spinal anaesthesia for patients with coronavirus disease 2019 and possible transmission rates in anaesthetists: retrospective, single-centre, observational cohort study. Br J Anaesth. 2020;124:670–675. doi: 10.1016/j.bja.2020.03.007. PubMed DOI PMC

Lin EE, et al. Incidence of COVID-19 in pediatric surgical patients among 3 US Children's Hospitals. JAMA Surg. 2020 doi: 10.1001/jamasurg.2020.2588. PubMed DOI PMC

Leung K, Wu JT, Liu D, Leung GM. First-wave COVID-19 transmissibility and severity in China outside Hubei after control measures, and second-wave scenario planning: a modelling impact assessment. Lancet. 2020;395:1382–1393. doi: 10.1016/S0140-6736(20)30746-7. PubMed DOI PMC

Lurie N, Saville M, Hatchett R, Halton J. Developing covid-19 vaccines at pandemic speed. N. Engl. J. Med. 2020;382:1969–1973. doi: 10.1056/NEJMp2005630. PubMed DOI

Pearce N, Lawlor DA, Brickley EB. Comparisons between countries are essential for the control of COVID-19. Int. J. Epidemiol. 2020 doi: 10.1093/ije/dyaa108. PubMed DOI PMC

Injury, G. B. D. T. B. & Spinal Cord Injury, C. Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol.18, 56–87, 10.1016/S1474-4422(18)30415-0 (2019). PubMed PMC

Robinson RG. Chronic subdural hematoma: surgical management in 133 patients. J. Neurosurg. 1984;61:263–268. doi: 10.3171/jns.1984.61.2.0263. PubMed DOI

Pinggera D, Klein B, Thome C, Grassner L. The influence of the COVID-19 pandemic on traumatic brain injuries in Tyrol: experiences from a state under lockdown. Eur. J. Trauma Emerg. Surg. 2020 doi: 10.1007/s00068-020-01445-7. PubMed DOI PMC

De Filippo O, et al. Reduced rate of hospital admissions for ACS during covid-19 outbreak in Northern Italy. N. Engl. J. Med. 2020 doi: 10.1056/NEJMc2009166. PubMed DOI PMC

Liu K, Pan M, Xiao Z, Xu X. Neurological manifestations of the coronavirus (SARS-CoV-2) pandemic 2019–2020. J. Neurol. Neurosurg. Psychiatry. 2020;91:669–670. doi: 10.1136/jnnp-2020-323177. PubMed DOI

Beyrouti, R. et al. Characteristics of ischaemic stroke associated with COVID-19. J. Neurol. Neurosurg. Psychiatr. 10.1136/jnnp-2020-323586 (2020). PubMed PMC

Perin, A., Servadei, F., DiMeco, F., Hub & Spoke' Lombardy Neurosurgery, G. May we deliver neuro-oncology in difficult times (e.g. COVID-19)? J. Neurooncol.148, 203–205, 10.1007/s11060-020-03496-7 (2020). PubMed PMC

Brindle ME, Doherty G, Lillemoe K, Gawande A. Approaching surgical triage during the COVID-19 pandemic. Ann. Surg. 2020 doi: 10.1097/SLA.0000000000003992. PubMed DOI PMC

Zubair, A. S. et al. Neuropathogenesis and neurologic manifestations of the coronaviruses in the age of coronavirus disease 2019: a review. JAMA Neurol.10.1001/jamaneurol.2020.2065 (2020). PubMed PMC

Pleasure SJ, Green AJ, Josephson SA. The spectrum of neurologic disease in the severe acute respiratory syndrome coronavirus 2 pandemic infection: neurologists move to the frontlines. JAMA Neurol. 2020 doi: 10.1001/jamaneurol.2020.1065. PubMed DOI

Current trends and outcomes of non-elective neurosurgical care in Central Europe during the second year of the COVID-19 pandemic