Lessons Learned From the Pandemic: A Retrospective Analysis of the Impact of COVID-19 in the Routine of a Reference Center for Spine Surgery

TL;DR

This study examines how the pandemic affected spine surgery operations at a Canadian hospital, showing changes in surgical volume and case types.

Contribution

The study provides insights into how a tertiary hospital adapted to pandemic restrictions and recovered post-vaccination.

Findings

Emergency surgeries increased during the pandemic, while elective surgeries decreased.

Complication rates dropped during the pandemic but rose again post-vaccination.

Preoperative waiting times increased significantly after vaccination rollout.

Abstract

Introduction: The COVID-19 pandemic significantly impacted the operating room schedules and reduced spine-related surgical activity around the world. With the widespread adoption of vaccination and the gradual easing of restrictions in Canada, the healthcare system has largely returned to its pre-pandemic operational capacity.

Methods: This retrospective study evaluated spine surgery activities at Centre Hospitalier de l’Université de Montréal (CHUM), a tertiary academic hospital in Canada. Three continuous but distinct periods were analyzed: pre-pandemic (P1) extended from March 2018 to February 2020; pandemic period (P2), from March 2020 to June 2021; and post-vaccination period (P3), from July 2021 to September 2022. Data on surgical volume, type of surgery (scheduled vs. emergency), mean preoperative waiting time, complication rates, and 30-day mortality rates were compared across the three periods.

Results: A total of 1,775 surgeries were performed during the study period. The monthly surgical volume averaged 34.6 in P1 (820 in total), decreased to 33.8 in P2 (540 in total), and rebounded to 37.7 in P3 (415 in total). Emergency surgeries accounted for 31% of cases in P1, increased to 52% in P2, and decreased to 35% in P3 (p = 0.03) (256, 281, and 144, respectively). Complication rates declined from 10.1% in P1 to 5.6% in P2 and then rose to 10.6% in P3 (p < 0.01) (83, 30, and 44, respectively). The mean preoperative waiting times were 131.3 days in P1, 118.4 days in P2, and 178.8 days in P3 (p < 0.01). The 30-day mortality rate remained less than 1% across all periods.

Conclusion: This work showed the steady volume of surgical activity during the pandemic in a tertiary center. This phenomenon happened largely due to the change in profile in surgical cases. Non-elective cases became more frequent, and elective patients were sparse, probably demonstrating the necessity to deal with cases that otherwise would be treated in community hospitals. Despite this fact, the complication rate decreased during the pandemic, and the mortality rate stayed stable. As the application of the vaccine in the Canadian population, elective spine surgery activity levels were successfully restored.

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