COVID-19: Spinal surgeons report “elevated anxiety and uncertainty for the future”

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Study authors (l-r) Philip Louie and Dino Samartzis

The full findings of a global survey of spinal surgeons on the impact of the COVID-19 pandemic have been published in the Global Spine Journal, and point to “elevated anxiety, uncertainty for the future and the need for standardised guidelines” among professionals in the field. A total of 902 spinal surgeons from the AO Spine membership responded to the 73-question survey, representing 91 countries and seven global regions, which was compiled by lead authors Philip Louie, (Hospital for Special Surgery, New York, USA) and Dino Samartzis (Rush Medical College, Chicago, USA).

The study indicates that COVID-19 has had varying impact on clinical practice among spinal surgeons, with most reporting cancellation of in excess of 75% of their surgical cases per week (539/803; 67.1%), although differences in reported cancellation rate were seen across geographic regions. Similar discrepancies are present with ongoing elective and emergency surgical cases, with variation in precaution recommendations for procedures, the study suggests.

Greatest current stressors reported by respondents included concerns about family health (76%), followed by economic issues (45.7%), the timeline to resume normal practice (44.9%), and community health (43.9%), with respondents reporting that stress relief was primarily being sought through reading, television, meditation, research, family, and telecommunication with friends was comparable between regions.

In the study, 23% of the surgeons reported working outside their normal scope of practice, “illustrating the unique challenges facing physicians not often at the forefront of the COVID-19 conversation”, with varying levels of concern in the mounting pressure.

Eighty-three per cent of respondents stated that they have access to testing, with contact with symptomatic patients being described as the most common reason to seek testing. However, only 7% of the physicians surveyed had undergone formal COVID-19 testing; with 47% stating that they know someone who has been diagnosed. Of those tested, 16% tested positive. Louie and Samartzis are quick to note that, “Our study further underscores that spine surgeons are not immune to this virus and need to take precautions in managing their patients to prevent transmission.” The authors further noted that their study also identified high-risk groups of spine surgeons with multiple co-morbidities themselves. “Our study is further testament that spine surgeons are not the healthiest healthcare professionals out there and they themselves may fall into a high-risk group for potential COVID-19-related complications if ever infected,” remarked the authors.

Overall, Louie, Samartzis and colleagues report that spine surgeons exhibited elevated anxiety and uncertainty for the future. “The lower rates of testing and diagnosis among our cohort, compared with the general population, suggest surgeons’ knowledge of disease transmission and/or possible greater adherence to public health measures aimed at limiting exposure,” they write.

On the curtailment of elective cases, the survey found that 81% of respondents were no longer performing elective surgery, although the majority (87%) are performing emergency/essential surgery. “The current pause on elective surgery has brought much consideration of time frames upon which surgeons can safely resume elective surgeries,” Louie and Samartzis noted. “Our findings indicate that the majority of respondents (49%) have yet to receive a time frame for resuming elective cases. Returning to normal is a crucial issue because economic concerns were the second greatest stressor, and more than 67% of respondents reported decreased income during the pandemic.”

Another area highlighted through the survey is the challenge facing surgeons in COVID-19 patients requiring surgery. When asked about performing surgery on COVID-19 patients, 70% of respondents recommended against surgery at this time.

Beyond recommendations against surgery, the study reports that 44% of surgeons attested to donning additional personal protective equipment (PPE) during the surgery of COVID-19 patients. “The allocation and utilisation of PPE has become a controversial issue among leadership because shortages take on a seemingly linear relationship to rates of disease,” the study’s authors note. Only half of the surgeons felt that their hospitals provide adequate PPE for frontline workers, whereas the remainder stated inadequate PPE resources. Regional analysis revealed that 27% of surgeons in Africa felt that they have adequate PPE, followed by Latin America (35%), the Middle East (36%), and Australia (38%). Of the forms of PPE provided, the following were the most common: surgical masks (88%), gowns (59%), N-95 masks (54%), and face shields (50%). Regional analysis demonstrated that North America (84%) and Australia (75%) have the greatest access to N95 masks, whereas the Middle East (33%) and Africa (23%) have the least access.

Discussing the findings, Louie, Samartzis and colleagues write: “To our knowledge, our study is the first to assess the multidimensional impact of COVID-19 on surgeons worldwide. With >900 respondents worldwide, we noted variations between regions for COVID-19 testing, government/leadership perceptions, impact of media/news outlets, hospital capacity for COVID-19, and economic consequences. We identified that 16% of all spine surgeons who underwent viral testing globally tested positive for COVID-19, and up to 13% would be less likely and not at all compelled to disclose their positive testing to their patients. The study also noted an overwhelming need for guidelines to manage patients under a pandemic. It noted that key PPEs, such as masks, face shields, gowns, and so on, were not readily available to clinicians.”

The authors further noted that “The surgeon is the forgotten soldier and commonly left out of the conversation as it surrounds this pandemic. Our study raises awareness to this unique, yet vital group of healthcare professionals and the impact variations that may exist among our global community.” The authors further noted, that “Although variations of impact were identified between regions, several similarities also existed, speaking to the point that collectively we are more intertwined than previously imagined and working together we can plan ahead and prepare for the next wave of this or any future pandemic.”


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