Khan Asham, Mao Jennifer Z, Soliman Mohamed A R, Rho Kyungduk, Hess Ryan M, Reynolds Renée M, Riley Jonathan P, Mullin Jeffrey P, Siddiqui Adnan H, Levy Elad I, Pollina John
Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States.
Department of Neurosurgery, Cairo University, Cairo, Egypt.
Surg Neurol Int. 2021 Jun 7;12:271. doi: 10.25259/SNI_240_2021. eCollection 2021.
COVID-19 has had a significant impact on the economy, health care, and society as a whole. To prevent the spread of infection, local governments across the United States issued mandatory lockdowns and stay-at-home orders. In the surgical world, elective cases ceased to help "flatten the curve" and prevent the infection from spreading to hospital staff and patients. We explored the effect of the cancellation of these procedures on trainee operative experience at our high-volume, multihospital neurosurgical practice.
Our department cancelled all elective cases starting March 16, 2020, and resumed elective surgical and endovascular procedures on May 11, 2020. We retrospectively reviewed case volumes for 54 days prelockdown and 54 days postlockdown to evaluate the extent of the decrease in surgical volume at our institution. Procedure data were collected and then divided into cranial, spine, functional, peripheral nerve, pediatrics, and endovascular categories.
Mean total cases per day in the prelockdown group were 12.26 ± 7.7, whereas in the postlockdown group, this dropped to 7.78 ± 5.5 ( = 0.01). In the spine category, mean cases per day in the prelockdown group were 3.13 ± 2.63; in the postlockdown group, this dropped to 0.96 ± 1.36 ( < 0.001). In the functional category, mean cases per day in the prelockdown group were 1.31 ± 1.51, whereas in the postlockdown group, this dropped to 0.11 ± 0.42 ( < 0.001). For cranial ( = 0.245), peripheral nerve ( = 0.16), pediatrics ( = 0.34), and endovascular ( = 0.48) cases, the volumes dropped but were not statistically significant decreases.
The impact of this outbreak on operative training does appear to be significant based solely on statistics. Although the drop in case volumes during this time can be accounted for by the pandemic, it is important to understand that this is a multifactorial effect. Further studies are needed for these results to be generalizable and to fully understand the effect this pandemic has had on trainee operative experience.
新型冠状病毒肺炎（COVID-19）对经济、医疗保健以及整个社会都产生了重大影响。为防止感染传播，美国各地的地方政府发布了强制封锁令和居家令。在外科领域，择期手术暂停以帮助“ flatten the curve”（此处“flatten the curve”未给出准确对应中文释义，可直译为“ flatten the curve”，通常意思为减缓疫情传播曲线，即控制疫情传播速度）并防止感染传播给医院工作人员和患者。我们探讨了取消这些手术对我们高流量、多医院神经外科实践中实习医生手术经验的影响。
我们科室从2020年3月16日起取消了所有择期手术，并于2020年5月11日恢复了择期手术和血管内介入手术。我们回顾性分析了封锁前54天和封锁后54天的病例数量，以评估我们机构手术量下降的程度。收集手术数据，然后将其分为颅脑、脊柱、功能、周围神经、儿科和血管内介入等类别。
封锁前组每天的平均总病例数为12.26±7.7，而封锁后组降至7.78±5.5（ = 0.01）。在脊柱类别中，封锁前组每天的平均病例数为3.13±2.63；封锁后组降至0.96±1.36（ < 0.001）。在功能类别中，封锁前组每天的平均病例数为1.31±1.51，而封锁后组降至0.11±0.42（ < 0.001）。对于颅脑（ = 0.245）、周围神经（ = 0.16）、儿科（ = 0.34）和血管内介入（ = 0.48）病例，手术量有所下降，但差异无统计学意义。
仅从统计数据来看，此次疫情对手术培训的影响似乎很大。虽然这段时间病例数量的下降可归因于疫情，但重要的是要明白这是一个多因素的影响。需要进一步研究以使这些结果具有普遍性，并充分了解此次疫情对实习医生手术经验的影响。
