A risk assessment strategy to re-introduce elective neurosurgery patients during COVID-19

Abstract

Objectives

To demonstrate the utilisation of a risk assessment protocol designed to prioritise elective neurosurgical patients against the risks of COVID-19. This tool can be applied to all other surgical specialties.

Design

Prospective case series of 166 patients.

Setting

Single-centre tertiary neurosurgical department.

Participants

All patients awaiting an elective neurosurgical procedure were included in this study. All emergency or life-threatening neurosurgical pathologies affecting patients were excluded.

Main outcome measures

The risk assessment tool identified patients with progressive neurology and stratified need for surgery against risk of harm during the COVID-19 pandemic.

Results

Using our risk stratification tool, 6.6% patients required expedited surgery and a further 11.4% patients were removed completely from the waiting list. The majority of patients 47%, required surgery within 3 months.

Conclusions

This simple tool encourages surgical departments to establish contact with patients during COVID-19. The clinician acquires up-to-date information regarding patient symptomatology and subsequently determines surgical priority, a timescale required for surgery and overall uses of NHS resources efficiently. We recommend the use of this tool for all neurosurgical departments, with a wider application to other surgical specialties during the ongoing pressures of elective backlogs secondary to the persistent COVID-19 pandemic.

Keywords:

• Elective neurosurgery
• COVID-19
• risk assessment tool

Disclosure statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. No potential conflict of interest was reported by the author(s).

Author contributions and guarantor information

Amir Saam Youshani: ASY

Chelsea Whittle: CW

Kaushik Ghosh: KG (corresponding author)

KG conceptualised the study. CW was involved with data curation. ASY analysed the data and developed the manuscript. ASY and KG performed the literature search and drafted the manuscript. ASY, CW and KG approved the final manuscript for submission. KG supervised the overall project and study. ‘The corresponding author attests that all listed authors meet authorship criteria and that no other meeting the criteria have been omitted’.

Copyright/license for publication

The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, a worldwide licence to the Publishers and its licensees in perpetuity, in all forms, formats and media (whether known now or created in the future), to (i) publish, reproduce, distribute, display and store the Contribution, (ii) translate the Contribution into other languages, create adaptations, reprints, include within collections and create summaries, extracts and/or, abstracts of the Contribution, (iii) create any other derivative work(s) based on the Contribution, (iv) to exploit all subsidiary rights in the Contribution, (v) the inclusion of electronic links from the Contribution to third party material where-ever it may be located; and, (vi) licence any third party to do any or all of the above.