Impact of COVID-19 on a Neurosurgical Service: Lessons from the University of California, San Diego (USA).

OBJECTIVE: The University of California at San Diego (UCSD) Health system's institution-wide response to the COVID-19 pandemic was founded on rapid development of in-house testing capacity, optimization of PPE usage, expansion of ICU capacity, development of analytic dashboards for monitoring of institutional status, and implementation of an OR triage plan that postponed non-essential/elective procedures. Here we analyze the impact of this triage plan on the only academic neurosurgery center in San Diego County, California, USA. METHODS: We conducted a de-identified retrospective review of all operative cases and procedures performed by UCSD Department of Neurosurgery faculty from November 24, 2019, through July 6, 2020, a 226-day period. Statistical analysis involved two-sample z-tests assessing daily case totals over the 113-day periods prior to and after implementation of the OR triage plan on March 16, 2020. RESULTS: A total of 1429 surgical and interventional radiologic procedures were performed by the neurosurgical service over the study period. There was no statistically significant difference in the mean number of daily total cases in the pre- versus post-triage plan periods (6.9 versus 5.8 mean daily cases, respectively; 1-tail p = 0.050, 2-tail p = 0.101), a trend reflected by nearly every category of neurosurgical cases. CONCLUSIONS: We show that during the COVID-19 pandemic, the UCSD Department of Neurosurgery maintained an operative volume that was only modestly diminished and continued to meet the essential neurosurgical needs of a large population. Lessons from our experience can guide other departments as they triage neurosurgical cases to meet community needs.