Impact of covid-19 on Spine Surgeries in Brazil's Health System

Introduction: The SARS-COV-2 pandemic has overwhelmed several health systems around the world, making it necessary to reduce some medical activities to meet the demand for hospitalizations by COVID-19 and avoid the intire collapse. Suspension of surgeries had been adopted in many countries, especially the electives. Impacts on Neurosurgery have been reported in other countries, but the impacts in Brazil have not yet been explored, especially in the Spine Surgery field. Our objective is to characterize the impact of COVID-19 on elective and urgent Spine neurosurgeries in Brazil during the first two waves of cases.

Methods: This is a descriptive study, based on aggregated data on neurosurgical procedures performed between January 2017 and September 2021. retrospectively collected by the Unified Health System Database-DATASUS. Data were analyzed according to the type of procedure and character of care (urgency/elective). Descriptive and simple inferential analysis were performed to assess the mean difference of the procedures productivity between the pre-pandemic and pandemic period.

Results: The avarege number of Neurosurgical procedures in the Brazilian public health system was 8,787.4 per month before Covid-19 had emerged, of which, 41,8% were electives and 58,2% urgent procedures. The mean monthly number of neurosurgeries decreased 22,2% in the Pandemic period. This dropdown is especially seen with electives surgeries(-42,82%). Regarding spine surgeries, the elective procedures before the pandemic period had a mean number of procedures of 662.8(±58), and turned to 328.8(±83.7), a a decrease of 50.3%(p < 0,001). Urgent procedures also showed a decrease of 13.6%(p < 0,001). The most impacted elective procedures with a statistical significance were posterior arthrodesis(-55.1%), discectomy(-51.9%), cervical anterior arthrodesis(-51.3%), decompressive surgeries(-47.3%), posterior cervical arhrodesis(-37%), and intramedular tumor ressection(-34.3%).

Conclusion : Covid-19 overwhelmed Spine surgery departments, specially regarding elective procedures. Based on our findinds, we suppose that many patients had a lost the optimal timing to operate, facing worsened outcomes as an unfortunate consequence.