The Impact of the SARS-CoV2 Pandemic on Post-Operative Outcomes Following Elective Spine Surgery: A Case-Control Study Performed in a Large SARS-CoV2 Epicenter

Introduction: The World Health Organization declared COVID-19 a global pandemic on March 11, 2020, leading to the suspension of elective orthopedic surgeries by March 17, 2020. Patients who underwent surgery from March 1-16, 2020, experienced post-operative recovery during the peak of the pandemic in New York City, a major epicenter of SARS-CoV-2. The effects of pandemic-related healthcare changes on surgical outcomes are not fully understood.

Methods: We analyzed demographics, surgical data, complications, readmissions, and reoperations at 30 days, 90 days, and 2 years for 60 patients who underwent spine surgery March 1-16, 2020. We compared this study group to a control cohort of 60 age, sex, BMI, and Charlson Comorbidity Index (CCI)-matched patients from the same period 2 years prior (March 1-16, 2018).

Results: Although there was no significant CCI difference between the groups (p=0.508), the COVID-19 group exhibited significantly higher ASA classes, with 35% classified as ASA III (vs 31.7%), 85% as ASA II (vs 63.3%), and 6.7% as ASA I (vs 18.3%).
Weakness was reported as an indication for surgery in 30% of the COVID group but only 10% of the pre-COVID group (p=0.014). There were no significant differences in back pain, radicular pain, or numbness as surgical indications.
There were no significant differences in lost-to-follow-up rates at 30 days (3% for both groups, p=1.0), 90 days (12% for the COVID group and 6% for the pre-COVID group, p=0.201), and 2 years (34% for the COVID group and 36% for the pre-COVID group, p=0.853). The rate of post-operative visit telemedicine usage was significantly higher in the COVID group (81.7% vs 23.3%, p< 0.001). Overall, there were no significant differences in lost-to-follow-up, complication, readmission, or reoperation rates between the COVID and pre-COVID groups at any timepoint.

Conclusion : Despite the challenges posed by the COVID-19 pandemic, there were no significant differences in outcomes between the COVID and pre-COVID groups. Thoughtful patient selection and telemedicine use likely contributed to maintaining continuity of care and ensuring optimal outcomes.