Educational impact of early COVID-19 operating room restrictions on neurosurgery resident training in the United States: A multicenter study

Justin K Zhang; Armando Del Valle; Sven Ivankovic; Niel Patel; Georgios Alexopoulos; Maheen Khan; Sulaman Durrani; Mayur Patel; Najib El Tecle; Nanthiya Sujijantarat; Amanda V Jenson; Samer G Zammar; Kristin Huntoon; Carlos R Goulart; Brandon M Wilkinson; Sujit Bhimireddy; Gavin W Britz; Michael DiLuna; Daniel M Prevedello; Dzung H Dinh; Tobias A Mattei

doi:10.1016/j.xnsj.2022.100104

Educational impact of early COVID-19 operating room restrictions on neurosurgery resident training in the United States: A multicenter study

N Am Spine Soc J. 2022 Feb 19:9:100104. doi: 10.1016/j.xnsj.2022.100104. eCollection 2022 Mar.

Authors

Justin K Zhang¹, Armando Del Valle¹, Sven Ivankovic², Niel Patel¹, Georgios Alexopoulos¹, Maheen Khan¹, Sulaman Durrani¹, Mayur Patel¹, Najib El Tecle¹, Nanthiya Sujijantarat³, Amanda V Jenson⁴, Samer G Zammar⁵, Kristin Huntoon⁶, Carlos R Goulart⁷, Brandon M Wilkinson⁷, Sujit Bhimireddy², Gavin W Britz⁴, Michael DiLuna³, Daniel M Prevedello⁶, Dzung H Dinh², Tobias A Mattei¹

Affiliations

¹ Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US.
² Department of Neurological Surgery, University of Illinois College of Medicine Peoria, Peoria, Illinois, 61605, US.
³ Department of Neurosurgery, Yale University, New Haven, Connecticut, 06510, USA.
⁴ Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas, 77030, US.
⁵ Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania, 17033, US.
⁶ Department of Neurosurgery, The Ohio State University, Columbus, Ohio, 43210, USA.
⁷ Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, 13210, US.

Abstract

Background: The coronavirus (COVID-19) pandemic has caused unprecedented suspensions of neurosurgical elective surgeries, a large proportion of which involve spine procedures. The goal of this study is to report granular data on the impact of early COVID-19 pandemic operating room restrictions upon neurosurgical case volume in academic institutions, with attention to its secondary impact upon neurosurgery resident training. This is the first multicenter quantitative study examining these early effects upon neurosurgery residents caseloads.

Methods: A retrospective review of neurosurgical caseloads among seven residency programs between March 2019 and April 2020 was conducted. Cases were grouped by ACGME Neurosurgery Case Categories, subspecialty, and urgency (elective vs. emergent). Residents caseloads were stratified into junior (PGY1-3) and senior (PGY4-7) levels. Descriptive statistics are reported for individual programs and pooled across institutions.

Results: When pooling across programs, the 2019 monthly mean (SD) case volume was 214 (123) cases compared to 217 (129) in January 2020, 210 (115) in February 2020, 157 (81), in March 2020 and 82 (39) cases April 2020. There was a 60% reduction in caseload between April 2019 (207 [101]) and April 2020 (82 [39]). Adult spine cases were impacted the most in the pooled analysis, with a 66% decrease in the mean number of cases between March 2020 and April 2020. Both junior and senior residents experienced a similar steady decrease in caseloads, with the largest decreases occurring between March and April 2020 (48% downtrend).

Conclusions: Results from our multicenter study reveal considerable decreases in caseloads in the neurosurgical specialty with elective adult spine cases experiencing the most severe decline. Both junior and senior neurosurgical residents experienced dramatic decreases in case volumes during this period. With the steep decline in elective spine cases, it is possible that fellowship directors may see a disproportionate increase in spine fellowships in the coming years. In the face of the emerging Delta and Omicron variants, programs should pay attention toward identifying institution-specific deficiencies and developing plans to mitigate the negative educational effects secondary to such caseloads reduction.

Keywords: ACGME, Accreditation Council for Graduate Medical Education; COVID-19; COVID-19, coronavirus disease of 2019; Case volume; Coronavirus; Multicenter; Neurosurgery training; OR, operating room; PGY, postgraduate year; Residency.