Early Responses of Neurosurgical Practice to the Coronavirus Disease 2019 (COVID-19) Pandemic: A Rapid Review

BACKGROUND: The novel coronavirus and subsequent pandemic have drastically transfigured health care delivery. Surgical specialties have seen severe alterations or reductions to practice, with neurosurgery being one example in which staff and resource reallocation has occurred to meet wider public health needs. This review summarizes the published evidence detailing early experiences and changes to neurosurgical practice in response to the coronavirus disease 2019 (COVID-19) pandemic. METHODS: A systematic review was conducted up until April 21, 2020 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, by searching Medline, EMBASE, PubMed, Scopus, Cochrane Central, and Web of Science Core Collection databases. Individual studies were qualitatively assessed to outline core themes detailing changes to practice. Iterative analysis allowed themes to be developed and applied to all studies included in the review. RESULTS: In total, 13 themes from 18 studies were identified, grouped into 3 overriding themes: logistics, human resources, and clinical delivery. Studies originated from 3 of the most affected countries (United States, China, and Italy), comprising expert opinions, letters to the editor, editorials, case reports, or perspective pieces. The commonest themes discussed include cancellation of elective operations, reduction in outpatient services, and pandemic rotas. CONCLUSIONS: This review summarizes the early responses of the neurosurgical community to the COVID-19 pandemic and presents a menu of interventions to be considered in future pandemic response, or in recurrent outbreaks of COVID-19. Whilst our review is limited by the low quality of evidence and rapid rate of change in our understanding of COVID-19, it provides a valuable summary of initial responses by the neurosurgical community to a global pandemic.