Impact of the COVID-19 pandemic on surgical volume and outcomes in spine surgery: a multicentre retrospective study in Tokyo

Yasushi Oshima; Nozomu Ohtomo; Naohiro Kawamura; Akiro Higashikawa; Nobuhiro Hara; Takashi Ono; Yujiro Takeshita; Masayoshi Fukushima; Seiichi Azuma; So Kato; Yoshitaka Matsubayashi; Yuki Taniguchi; Sakae Tanaka

doi:10.1136/bmjopen-2023-077110

Impact of the COVID-19 pandemic on surgical volume and outcomes in spine surgery: a multicentre retrospective study in Tokyo

BMJ Open. 2023 Nov 29;13(11):e077110. doi: 10.1136/bmjopen-2023-077110.

Authors

Yasushi Oshima^{1

2}, Nozomu Ohtomo^{3

2}, Naohiro Kawamura^{2

4}, Akiro Higashikawa^{2

5}, Nobuhiro Hara^{2

6}, Takashi Ono^{2

7}, Yujiro Takeshita^{2

8}, Masayoshi Fukushima^{2

9}, Seiichi Azuma^{2

10}, So Kato^{3

2}, Yoshitaka Matsubayashi^{2

11}, Yuki Taniguchi^{3

2}, Sakae Tanaka³

Affiliations

¹ Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo-ku, Japan yoo-tky@umin.ac.jp.
² University of Tokyo Spine Group (UTSG), Tokyo, Japan.
³ Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo-ku, Japan.
⁴ Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Shibuya, Japan.
⁵ Department of Orthopedic Surgery, Kanto Rosai Hospital, Yokohama, Kanagawa, Japan.
⁶ Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
⁷ Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan.
⁸ Department of Orthopedic Surgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan.
⁹ Toranomon Hospital, Minato-ku, Japan.
¹⁰ Department of Orthopedic Surgery, Japanese Red Cross Saitama Hospital, Saitama, Japan.
¹¹ Department of Orthopaedic Surgery and Spinal Surgery, National Center for Global Health and Medicine, Shinjuku-ku, Japan.

Abstract

Objectives: To investigate the effect of the COVID-19 pandemic on surgical volume and outcomes in spine surgery.

Design: A retrospective cohort study using prospectively collected data.

Setting and participants: A total of 9935 patients who underwent spine surgery between January 2019 and December 2021 at eight high-volume spine centres in the Greater Tokyo metropolitan area were included.

Outcome measures: The primary outcome measures were the number of surgical cases, perioperative complications and patient-reported outcomes, including numerical rating scales for each body part, Euro quality of life 5-dimension (EQ5D), Neck Disability Index and Oswestry Disability Index (ODI).

Results: The total number of surgeries in 2020 and 2021 remained lower than that of 2019, with respective percentages of 93.1% and 95.7% compared with the prepandemic period, with a marked reduction observed in May 2020 compared with the same period in 2019 (56.1% decrease). There were no significant differences between the prepandemic and postpandemic groups in the incidence of perioperative complications, although the frequency of reoperation tended to be higher in the postpandemic group (3.04% vs 3.76%, p=0.05). Subgroup analysis focusing on cervical spine surgery revealed significantly worse preoperative EQ5D scores in the postpandemic group (0.57 vs 0.54, p=0.004). Similarly, in lumbar spine surgery, the postpandemic group showed higher levels of leg pain (5.7 vs 6.1 to 0.002) and worse ODI scores (46.2 vs 47.7 to 0.02). However, postoperative outcomes were not different between pre and post-pandemic groups.

Conclusions: The COVID-19 pandemic has significantly impacted spinal surgeries in Japan, leading to a decrease in surgical volumes and changes in patient characteristics and surgical procedures. However, surgical outcomes remained comparable between the pre and postpandemic periods, indicating the resilience and adaptability of healthcare systems.

Keywords: ORTHOPAEDIC & TRAUMA SURGERY; Patient Reported Outcome Measures; Quality of Life; Spine.

Publication types

Multicenter Study

MeSH terms

COVID-19* / epidemiology
Humans
Lumbar Vertebrae / surgery
Pandemics*
Quality of Life
Retrospective Studies
Tokyo / epidemiology
Treatment Outcome