Introduction

Significant health care accessibility and administrative restrictions were imposed on hospitals providing care for individuals with spine pathology during the first wave of the COVID-19 pandemic. The purpose of this study was to elucidate the effect of COVID-19 on patient demographics, surgical care, logistics, and patient outcomes in spine patients.

Methods

This is a retrospective study of patients who had spine surgery at UCSD from 3/1/19 to 5/31/19 (pre-COVID-19) and 3/1/20 to 5/31/20 (first COVID-19 surge). 331 subjects met the study criteria. Demographic and surgical data were collected from medical records. Pain levels at pre-operative, discharge, short- (3-6 month) and long-term (9-15 month) timepoints were extracted.

Results

There were no significant differences in patient demographics including age, BMI, gender, race, ethnicity, ASA rating, smoking status, or diabetes status between groups (p>0.14). The diagnostic indications for surgery of spondylolisthesis, scoliosis, tumor/infection, and spondylosis/stenosis were less prevalent during COVID-19 (p<0.012), whereas a diagnostic indication of fracture was more prevalent (p<0.001). There were no differences in operating room duration and skin-to-skin time (p>0.64); however, length of stay was 4.7 days shorter during the COVID-19 pandemic (p=0.03), and more cases were classified as ‘urgent’ (p=0.04). There were less postoperative complications at 90 days (p=0.02), a lower reoperation rate (p<0.01), and a lower 90-day readmission rate (p=0.04) during COVID-19. Preoperative pain scores did not differ between groups (p=0.58); however, pain levels at discharge were significantly higher in patients operated upon during COVID (p=0.04). Pain scores trended towards remaining higher in the short- (p=0.06), but not long-term (p=0.21) after surgery (Table).

Discussion  

The pandemic resulted in a greater proportion of ‘urgent’ spine surgery cases and shorter hospital length of stay. Individuals undergoing surgery during this time had fewer surgery related complications and reoperations, potentially indicating more stringent patient selection. Pain levels upon discharge and at short-term timepoints were higher following surgery; however, these differences did not persist in the long term.