Abstract
BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or Covid-19), which began as an epidemic in China and spread globally as a pandemic, has necessitated resource management to meet emergency needs of Covid-19 patients and other emergent cases. We have conducted a survey to analyze caseload and measures to adapt indications for a perception of crisis.MethodsWe constructed a questionnaire to survey a snapshot of neurosurgical activity, resources, and indications during 1 week with usual activity in December 2019 and 1 week during SARS-CoV-2 pandemic in March 2020. The questionnaire was sent to 34 neurosurgical departments in Europe; 25 departments returned responses within 5 days.ResultsWe found unexpectedly large differences in resources and indications already before the pandemic. Differences were also large in how much practice and resources changed during the pandemic. Neurosurgical beds and neuro-intensive care beds were significantly decreased from December 2019 to March 2020. The utilization of resources decreased via less demand for care of brain injuries and subarachnoid hemorrhage, postponing surgery and changed surgical indications as a method of rationing resources. Twenty departments (80%) reduced activity extensively, and the same proportion stated that they were no longer able to provide care according to legitimate medical needs.ConclusionNeurosurgical centers responded swiftly and effectively to a sudden decrease of neurosurgical capacity due to relocation of resources to pandemic care. The pandemic led to rationing of neurosurgical care in 80% of responding centers. We saw a relation between resources before the pandemic and ability to uphold neurosurgical services. The observation of extensive differences of available beds provided an opportunity to show how resources that had been restricted already under normal conditions translated to rationing of care that may not be acceptable to the public of seemingly affluent European countries.Electronic supplementary materialThe online version of this article (10.1007/s00701-020-04482-8) contains supplementary material, which is available to authorized users.
Highlights
The severe acute respiratory syndrome coronavirus 2 (SARSCoV-2 or Covid-19) pandemic has forcibly affected healthcare in other subspecialties than the primarily involved: intensive care, infectious diseases, and general practice
Nineteen centers reported that all patients with legitimate medical needs could not expect to have those needs met during the Covid-19 pandemic in the March 2020 week, and several centers gave examples of patients with neurosurgical emergencies that would not be treated
The time points in December and March were chosen to reflect “regular practice” during a regular working week and practice affected by the Covid-19 pandemic in the vicinity of its European peak, respectively
Summary
The severe acute respiratory syndrome coronavirus 2 (SARSCoV-2 or Covid-19) pandemic has forcibly affected healthcare in other subspecialties than the primarily involved: intensive care, infectious diseases, and general practice. Regular neurosurgical emergences still occur [4] and the needs of these patients must be coordinated with the extraordinary demands of healthcare for Covid-19 patients. With terminology such as “triage” and “prioritization,” the public and professionals communicate that all medical needs can be met, extreme adjustment and measures are necessary (Mathiesen T., submitted). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or Covid-19), which began as an epidemic in China and spread globally as a pandemic, has necessitated resource management to meet emergency needs of Covid-19 patients and other emergent cases. We have conducted a survey to analyze caseload and measures to adapt indications for a perception of crisis
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