Academic Output of the Neurosurgery Profession During the COVID-19 Pandemic

The consequences of the COVID-19 pandemic were rapid in onset and widespread in nature, and they are still being realized today, months after the crisis's origin. The focus of the global health care environment has been radically shifted, with institutions worldwide reacting to a massive influx of critically ill patients. As a consequence, routine health maintenance and elective medical procedures have been deferred in many regions. In response to the growing European and Asian continental health care crisis, the American College of Surgeons issued guidance on March 13, 2020 recommending minimizing or cancelling all elective procedures and surgeries until a predetermined regional inflection point in COVID-19 infections and critical care needs.¹ Furthermore, the US Centers for Disease Control and Prevention developed a framework for providing non−COVID-19 health care during the pandemic, with elective surgeries and procedures categorized as least likely to lead to patient harm with deferral of services.² Responding to a rapidly growing volume of patients, New York state governor Andrew Cuomo mandated in March 2020 all elective surgeries cancelled to dedicate hospital capacity for patients with SARS-CoV-2 infection.³

As a direct result of these and other regional public health enforcement, surgical volumes plummeted in the United States year-over-year between 2019 and 2020. According to a recent report (Figure 1 ), inpatient volumes for neurosciences and spine were down 50% and 60%, respectively.⁴ Overall, this has contributed to an overall monthly financial loss of nearly $60 billion across hospitals nationwide. But beyond the objective financial impact, the reduction in surgical and procedural volume has immense consequences for surgical residents and other medical trainees. In a retrospective analysis of our own institution in the pandemic epicenter, surgical volumes dropped by 59%.⁵ In another report, neurosurgical residents experienced a drop in case volume by more than 25% between March 16 and May 31, 2020.⁶ Another nationwide survey of neurosurgical residents documented a universal reduction in case volume and work hours.⁷ While this survey discussed alternatives for residents during the pandemic, including increased didactic time and use of electronic educational resources, many neurosurgical residency programs required reallocation of resident time away from surgical training toward in-demand critical care duties.⁸

Figure 1.

Changes in surgical case volume, separated by spine and cranial neurosurgeries, between March and June 2020. Data and figures provided by Strata Decision Technology.

With hospital resources diverted and elective surgery volume significantly decreased in regions hard hit by the COVID-19 pandemic, neurosurgical providers have been met with a unique challenge: how to make the best use of time. One potential avenue of time reallocation was academic productivity. The numbers suggest an increased output of neurosurgical publications during this time as the pandemic intensified throughout the world in the first half of 2020. According to a PubMed search using the MeSH term “Neurosurgery” between years 2010 and 2020 (Figure 2 ), there were 16,834 indexed articles between January 1, and July 27, 2020. This number is greater than the entire annual output from 2013 (15,511 articles) and 63% of the annual output from the year prior (26,838 articles) in just over half the time.⁹ Another search using the tool Dimensions.ai, a multisource academic search platform, results in 1208 articles with the terms “Neurosurgery” AND “COVID” published since the beginning of 2020. More than 350 articles (354, 29% of all articles) have been published with the terms “Neurosurgery” AND “COVID” AND “Perspective,” indicating a substantial portion of neurosurgical authors sharing their pandemic experiences. The top 3 countries from which these perspectives were shared include China, the United States, and Italy.

Figure 2.

Number of PubMed indexed articles involving neurosurgery, between 2010 and 2020. MeSH term “Neurosurgery.” ∗2020 data compiled from January 1−July 27.

These observations must be made with several caveats. First, this increase in total amount of publications year over year may be related to the continued trend of growth in neurosurgery research between 2010 and 2019 overall. The amount of PubMed-indexed publications increased 148% between 2010 and 2019, with an average annual growth of 10.8%. Second, given the inevitable delay between article submission and publication, there may be a large portion of COVID-era publications currently absent from the analysis that will come to print in several months.

While much of the world was locked down in isolation due to the COVID-19 pandemic, neurosurgical case volume dropped substantially and thus neurosurgical providers adopted new roles in critical care, administration, and remote education. Yet as the numbers suggest, we also made time to be academically productive and share personal and institutional experiences in the published literature. This mutual sharing of knowledge certainly benefitted neurosurgical practices in less severely affected regions, by learning triaging strategies and resource allocation processes described by those first hit by the COVID-19 pandemic.