A look at the global impact of COVID-19 pandemic on neurosurgical services and residency training

BACKGROUND: The COVID-19 pandemic has left an indelible effect on healthcare delivery and education system, including residency training. Particularly, neurosurgical departments worldwide had to adapt their operating model to the constantly changing pandemic landscape. This review aimed to quantify the reduction in neurosurgical operative volume and describe the impact of these trends on neurosurgical residency training. METHODS: We performed a comprehensive search of PubMed and EMBASE between December 2019 and October 2022 to identify studies comparing pre-pandemic and pandemic neurosurgical caseloads as well as articles detailing the impact of COVID-19 on neurosurgery residency training. Statistical analysis of quantitative data was presented as pooled odds ratio (OR) and 95% confidence intervals (CI). RESULTS: A total of 49 studies met the inclusion criteria, of which 12 (24.5%) were survey-based. The case volume of elective surgeries and non-elective procedures decreased by 70.4% (OR=0.296, 95%CI 0.210–0.418) and 68.2% (OR=0.318, 95%CI 0.193–0.525), respectively. A significant decrease was also observed in functional (OR=0.542, 95%CI 0.394–0.746), spine (OR=0.545, 95%CI 0.409–0.725), and skull base surgery (OR=0.545, 95%CI 0.409–0.725), whereas the caseloads for tumor (OR=1.029, 95%CI 0.838–1.263), trauma (OR=1.021, 95%CI 0.846–1.232), vascular (OR=1.001, 95%CI 0.870–1.152), and pediatric neurosurgery (OR=0.589, 95%CI 0.344–1.010) remained relatively the same between pre-pandemic and pandemic periods. The reduction in caseloads had caused concerns among residents and program directors in regard to the diminished clinical exposure, financial constraints, and mental well-being. Some positives highlighted were rapid adaptation to virtual educational platforms and increasing time for self-learning and research activities. CONCLUSION: While COVID-19 has brought about significant disruptions in neurosurgical practice and training, this unprecedented challenge has opened the door for technological advances and collaboration that broaden the accessibility of resources and reduce the worldwide gap in neurosurgical education.