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

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.

Keywords

spinal infection - vertebral osteomyelitis - spondylodiskitis - spinal fusion - spinal osteosynthesis

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

• References

• 1 Arnold PM, Owens L, Heary RF. et al. Lumbar spine surgery and what we lost in the era of the coronavirus pandemic: a survey of the lumbar spine research society. Clin Spine Surg 2021; 34 (10) E575-E579
• 2 Chen AS, Brown M, Arekelyan A, Wennemann S, Shamie N, Holly L, Holly L, Liu JC, Buser Z. et al. A tale of two institutions: COVID-19 positive rates in asymptomatic patients pre-screened for spine procedures and surgeries in Los Angeles, California. Global Spine J 2021; Dec 6:21925682211057489
• 3 Dermott JA, Kim DJ, Lebel DE. The impact of COVID-19 on idiopathic scoliosis referrals: cause for concern. Spine Deform 2021; 9 (06) 1501-1507
• 4 Mohammed R, Shah P, Durst A. et al; BASS Collaborative Study Group. Restoration of elective spine surgery during the first wave of COVID-19 : a UK-wide British Association of Spine Surgeons (BASS) prospective, multicentre, observational study. Bone Jt Open 2021; 2 (12) 1096-1101
• 5 Power FR, Juhdi A, Macken M, Synnott KA, Butler JS. The Impact of COVID-19 and lockdown on spinal services at a national level: lessons learned and areas of service improvement for future health care delivery. Clin Spine Surg 2022; 35 (01) 7-11
• 6 Sakti YM, Khadafi RN. Emergent spine surgery during COVID-19 pandemic: 10 months experience in Dr. Sardjito general hospital, Indonesia a case series. Ann Med Surg (Lond) 2021; 67: 102513
• 7 Wordie SJ, Tsirikos AI. The impact of the COVID-19 pandemic on spinal surgery. Orthop Trauma 2021; 35 (06) 314-320
• 8 Baayen RH, Davidson DJ, Bates DM. Mixed-effects modeling with crossed random effects for subjects and items. J Mem Lang 2008; 59: 390-412
• 9 Kliegl R, Masson MEJ, Richter EM. A linear mixed model analysis of masked repetition priming. Vis Cogn 2010; 18: 655-681
• 10 Bates D, Mächler M, Bolker B. et al. Fitting linear mixed-effects models using lme4. J Stat Softw 2015; 67: 1-48
• 11 R Core Team. A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2020
• 12 Moore BJ, White S, Washington R, Coenen N, Elixhauser A. Identifying increased risk of readmission and in-hospital mortality using hospital administrative data: the AHRQ Elixhauser comorbidity index. Med Care 2017; 55 (07) 698-705
• 13 Nachtigall I, Lenga P, Jóźwiak K. et al. Clinical course and factors associated with outcomes among 1904 patients hospitalized with COVID-19 in Germany: an observational study. Clin Microbiol Infect 2020; 26 (12) 1663-1669
• 14 Bollmann A, Hohenstein S, Meier-Hellmann A, Kuhlen R, Hindricks G. Emergency hospital admissions and interventional treatments for heart failure and cardiac arrhythmias in Germany during the Covid-19 outbreak: insights from the German-wide Helios hospital network. Eur Heart J Qual Care Clin Outcomes 2020; 6 (03) 221-222
• 15 Dengler J, Prass K, Palm F, et al. Changes in nationwide in-hospital stroke care during the first four waves of COVID-19 in Germany. Eur Stroke J. April 2022. doi:10.1177/23969873221089152
• 16 de Havenon A, Ney JP, Callaghan B. et al. Characteristics and outcomes among US patients hospitalized for ischemic stroke before vs during the COVID-19 pandemic. JAMA Netw Open 2021; 4 (05) e2110314
• 17 Diegoli H, Magalhães PSC, Martins SCO. et al. Decrease in hospital admissions for transient ischemic attack, mild, and moderate stroke during the COVID-19 era. Stroke 2020; 51 (08) 2315-2321
• 18 Dula AN, Gealogo Brown G, Aggarwal A, Clark KL. Decrease in stroke diagnoses during the COVID-19 pandemic: where did all our stroke patients go?. JMIR Aging 2020; 3 (02) e21608
• 19 Talamonti G, Colistra D, Crisà F, Cenzato M, Giorgi P, D'Aliberti G. Spinal epidural abscess in COVID-19 patients. J Neurol 2021; 268 (07) 2320-2326