J Neurol Surg A Cent Eur Neurosurg 2023; 84(01): 58-64
DOI: 10.1055/s-0042-1749353
Original Article

Effects of the COVID-19 Pandemic on Spinal Fusion Procedures for Spinal Infections in a Nationwide Hospital Network in Germany

Nehad Abduljawwad
1   Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Bad Saarow, Germany
2   Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany
,
Sunisha Pamnani
1   Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Bad Saarow, Germany
2   Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany
,
Michael Stoffel
3   Department of Neurosurgery, HELIOS Hospital Krefeld, Krefeld, Germany
,
Clayton N. Kraft
4   Department of Orthopedics, Trauma Surgery and Hand Unit, HELIOS Klinikum Krefeld, Krefeld, Germany
,
Aldemar A. Hegewald
5   Department of Neurosurgery, VAMED Ostsee Hospital Damp, Ostseebad Damp, Germany
,
Ralf Dörre
6   Department of Neurosurgery, HELIOS Hospital St. Marienberg, Helmstedt, Germany
,
Oliver Heese
7   Department of Neurosurgery and Spinal Surgery, HELIOS Hospital Schwerin - University Campus of MSH Medical School Hamburg, Schwerin, Germany
,
Rüdiger Gerlach
8   Department of Neurosurgery, HELIOS Hospital Erfurt, Erfurt, Germany
,
Steffen Rosahl
8   Department of Neurosurgery, HELIOS Hospital Erfurt, Erfurt, Germany
,
Bernd Maier
9   Department of Trauma and Orthopedic Surgery, HELIOS Hospital Pforzheim, Pforzheim, Germany
,
Ralf Burger
10   Department of Neurosurgery, HELIOS Hospital Uelzen, Uelzen, Germany
,
Sebastian Wutzler
11   Department of Trauma, Hand and Orthopedic Surgery, HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
,
Barbara Carl
12   Department of Neurosurgery, University of Marburg, Marburg, Germany
13   Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
14   Department of Neurosurgery, HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
,
Yu-Mi Ryang
15   Department of Neurosurgery and Spine Center, HELIOS Hospital Berlin Buch, Berlin, Germany
16   Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
,
Khanh Toan Hau
17   Department of Spine Surgery, HELIOS Hospital Duisburg, Duisburg, Germany
,
Gregor Stein
18   Department of Orthopaedic, Trauma and Spine Surgery, HELIOS Hospital Siegburg, Siegburg, Germany
,
Jens Gulow
19   Department of Spine Surgery, HELIOS Park-Klinikum Leipzig, Leipzig, Germany
,
Ralf Kuhlen
20   HELIOS Health GmbH, Berlin, Germany
,
Sven Hohenstein
21   Helios Health Institute, Leipzig, Germany
,
Andreas Bollmann
21   Helios Health Institute, Leipzig, Germany
22   Department of Electrophysiology, Heart Center Leipzig at Leipzig University, Germany
,
Julius Dengler
1   Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Bad Saarow, Germany
2   Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany
› Author Affiliations
Funding This study was funded by the Helios Center for Research and Innovation via a grant (HCRI ID 2020-0458) to JD.

Abstract

Background The full impact of the COVID-19 pandemic on surgical spine care is difficult to assess due to a lack in nationwide evidence from more recent phases of the pandemic. We aimed to describe changes in in-hospital processes associated with spinal fusion procedures in the treatment of spinal infections (SI) during different phases of the pandemic.

Methods In this retrospective observational study, we examined the in-hospital prevalence and outcomes of spinal fusion procedures for SI (along with patient characteristics, rates of transfer to intensive care units, and mortality rates) during the first four waves of the pandemic compared with the corresponding prepandemic periods in 2019. We used administrative data from a nationwide network of 76 hospitals managing 7% of all in-hospital cases in Germany.

Results We observed no significant change in the prevalence of SI fusion procedures during the pandemic, neither in total numbers (349 vs. 373) nor for each wave separately. On a patient level, we found no differences in age, sex, and the prevalence of paresis, and no relevant differences in associated comorbidities. The rate of mechanical ventilation did not change during any of the examined pandemic waves: it ranged between 9.5 and 18.6% during the pandemic and 3.1 and 16.0% during the corresponding prepandemic control periods. The rate of transfer to intensive care changed only during wave 4 (from 70.4 to 54.8%; p = 0.046) but not in any other pandemic phases. We observed no changes in in-hospital mortality rates (range: 2.9–9.7% vs. 6.2–11.3%) or in duration of hospital stay (range: 26.2–30.8 days vs. 20.8–29.2 days).

Conclusions The main finding of our study is that within this nationwide network of spine care centers in Germany, the delivery of surgical treatment of SI by means of spinal fusion procedures was maintained throughout the first four waves of the pandemic. Furthermore, there were no relevant changes in patient demographics, in-hospital processes, and mortality rates.

Disclosures

JD received funding through the Helios Center for Research and Innovation via a grant (HCRI ID 2020–0458). RK holds shares in Helios AG. CNK holds shares in Fresenius AG. GS is consultant to Brainlab AG and Aesculap AG. YR is a member of the DWG Advisory Board publication organ “Die Wirbelsäule, DWG Commissions (Science, Education, Quality Safety, Congress Program, Scientific Advisory Board publication organ “Die Wirbelsäule”), and Eurospine EduCom. All other authors declare no conflict of interest.




Publication History

Received: 21 January 2022

Accepted: 23 March 2022

Article published online:
27 June 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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