In Memoriam: A Memoir for Our Fallen "Heroes"

Less surgical site infections in neurosurgery during COVID-19 times-one potential benefit of the pandemic?

Hygiene measures were intensified when the COVID-19 pandemic began. Patient contacts were limited to a minimum. Visitors were either not allowed for a certain period or limited for the rest of the time. The hospital staff began to wear masks and gloves continuously. Clinical examinations and routine wound controls were also performed under intensified hygiene standards. These circumstances result in a limitation of direct physical interactions between the nursing staff, the physicians and the patients. We analyzed to what extent the intensification of hygiene measures affects the rate of surgical site infections (SSI) after neurosurgical procedures. The rate of SSI during the 6-month interval after the beginning of COVID-19 measures was compared with the SSI rate before. The numbers of the period before COVID-19 were analyzed as mean values resulting from the analysis of two separate time periods each consisting of 6 months. The spectrum of surgical procedures was compared. Patient-related risk factors for SSIs were noted. Microorganisms were analyzed. We focused on SSIs occurring at a maximum of 60 days after the primary surgery. Overall, in the two respective 6-month periods before COVID-19, a mean of 1379 patients was surgically treated in our institution. After the beginning of COVID-19 (starting from 04/2020) our surgical numbers dropped by 101, resulting in a total number of 1278 patients being operated after 03/2020 until 09/2020. The SSI rate was 3.6% (03/2019-09/2019, 50 SSIs) and 2.2% (09/2019-03/2020, 29 SSIs), resulting in a mean of 2.9% before COVID-19 began. After the beginning of COVID-19 hygiene measures, this rate dropped to 1.4% (16 SSIs) resembling a significant reduction (p=0.003). Risk factors for the development of SSI were present in 81.3% of all patients. Pre- and post-COVID-19 patient groups had similar baseline characteristics. The same holds true when comparing the percentage of cranial and spinal procedures pre- and post-COVID-19 (p=0.91). Comparing the numbers (p=0.28) and the species (p=0.85) of microorganisms (MO) causing SSI, we found a similar distribution. Despite equal demographics and characteristics of SSI, the rate of SSI dropped substantially. This argues for an effective reduction of postoperative SSI resulting from the implementation of strict hygiene measures being established after the beginning of the COVID-19 pandemic. We therefore advocate continuing with strict and intensive hygiene measures in the future.

Largest neurosurgical social media group and its impact on communication and research

BACKGROUND

The use of social media to communicate and disseminate knowledge has increased exponentially, especially in the field of neurosurgery. 'Neurosurgery cocktail' (NC) was developed by a group of young neurosurgeons as a means of sharing didactic materials and clinical experiences via social media. It connects 35.000 neurosurgeons worldwide on multiple platforms, primarily Facebook and Twitter. Given the rising utilization of social media in neurosurgery, the popularity of NC has also increased since its inception. In this study, the authors surveyed the social media analytics of NC for both Facebook and Twitter. Besides, we reviewed the literature on the use of social media in neurosurgery.

METHODS

Facebook and Twitter metrics were extracted through each respective platform's analytics tools from December 2020 (earliest available date for data analysis) through January 2021. A literature search was conducted using PubMed (MEDLINE) and Scopus databases.

RESULTS

On Facebook, as of January 2021, the group had a total of 25.590 members (87.6% male), most commonly (29%) between 35 and 44 years of age with over 100 countries were represented. As of January 2021, they had amassed 6457 followers on Twitter. During the last 28 d between December 2020 and January 2021, the account published 65 tweets that garnered a total of 196,900 impressions. Twelve articles were identified in our literature review on the use of social media within the neurosurgical community.

CONCLUSIONS

NC is one of the most widely utilized neurosurgical social media resources available. Sharing knowledge has been broadened thanks to the recent social media evolution, and NC has become a leading player in disseminating neurosurgical knowledge.

COVID-19 and Changes in Neurosurgical Workload in the United Kingdom

BACKGROUND

Cessation of elective procedures and lower bed capacity during the COVID-19 pandemic have led to a rise in the waiting lists for surgery, but it is unclear if workload has recovered sufficiently to account for this backlog. We describe the change in neurosurgical workload at a tertiary neurosciences center in the United Kingdom after the first pandemic wave in comparison with the months before and during the first wave.

METHODS

A retrospective review of theatre records and electronic referrals-between December 1, 2019, and August 31, 2020-was performed. The months of December 2019-February 2020 were designated as pre-COVID months and March-May 2020 were designated as COVID months. The time period from June to August 2020 was designated as post-wave months. Statistical analyses were performed on SPSS v22 (IBM).

RESULTS

Referrals declined from 572 in January to a nadir of 352 in April before a steady rise to August. Referral volumes for degenerative spinal disease and traumatic brain injuries showed a statistically significant change during the year. On average, 212 procedures per month were performed in the pre-COVID months, 167 procedures per month during COVID months, and 232 procedures per month in the post-wave months. The number of patients on the waiting list for scheduled operations rose from March (785 patients) onward to a peak of 997 patients in July.

CONCLUSIONS

In the aftermath of COVID-19, higher referral volumes and operative procedures were apparent in the post-wave months as services returned to normal. With the expectation of a second wave of infections, it is unclear whether this will be sustainable.

Geospatial Distribution of Neurosurgeons Age 60 and Older Relative to the Spread of COVID-19

OBJECTIVE

To perform an ecological study to analyze the geospatial distribution of neurosurgeons ≥60 years old and compare these data with the spread of 2019 novel coronavirus disease (COVID-19) across the United States.

METHODS

Data regarding distribution of COVID-19 cases were collected from the Environmental Systems Research Institute, and demographic statistics were collected from the American Association of Medical Colleges 2019 State Workforce Reports. These figures were analyzed using geospatial mapping software.

RESULTS

As of July 5, 2020, the 10 states with the highest number of COVID-19 cases showed older neurosurgical workforce proportions (the proportion of active surgeons ≥60 years old) of 20.6%-38.9%. Among states with the highest number of COVID-19 deaths, the older workforce proportions were 25.0%-43.4%. Connecticut demonstrated the highest with 43.4% of neurosurgeons ≥60 years old.

CONCLUSIONS

Regional COVID-19 hotspots may coincide with areas where a substantial proportion of the neurosurgical workforce is ≥60 years old. Continuous evaluation and adjustment of local and national clinical practice guidelines are warranted throughout the pandemic era.