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COVID-19 Impact on Cerebrospinal Fluid Diversion: A Single Institution Experience
Shelly Sharma1, Klaudia Dziugan1, Ava Kucera1
1Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.
Insights
The number of cerebrospinal fluid (CSF) diversion procedures for pediatric hydrocephalus remained stable during the COVID-19 pandemic. However, procedures for infection increased significantly, warranting further investigation.
Area of Science:
- Pediatric Neurosurgery
- Surgical Outcomes
- Public Health
Background:
- The COVID-19 pandemic saw decreased surgical interventions for conditions like myocardial infarction and stroke.
- It was hypothesized that pediatric cerebrospinal fluid (CSF) diversion procedures would also decrease.
- This study investigated changes in CSF diversion procedures during the pandemic.
Purpose of the Study:
- To determine if the number of CSF diversion procedures for pediatric hydrocephalus changed during the COVID-19 pandemic.
- To compare procedure volumes and patient demographics before and during the pandemic.
Main Methods:
- A retrospective chart review was conducted at a children's hospital.
- Data from March 2019 to February 2021 were analyzed, comparing pre-COVID-19 and COVID-19 periods.
- CSF diversion procedures included ETV, CPC, shunt placement, and revisions.
Main Results:
- No significant difference was found in the overall number of CSF diversion procedures performed.
- Patient demographics (gender, ethnicity, insurance) remained consistent between periods.
- A significant increase in CSF diversion procedures for infection was observed during the pandemic.
Conclusions:
- CSF diversion procedures for pediatric hydrocephalus did not significantly decrease during the COVID-19 pandemic.
- An increase in procedures for infection suggests potential multifactorial causes.
- Further research is needed to understand the rise in infection-related procedures.
Introduction:
Several studies have demonstrated that the absolute numbers of select surgical interventions for myocardial infarction, stroke, and appendicitis decreased during the COVID-19 pandemic, possibly due to overall decreased hospital presentation. We sought to identify if this pattern was also true for children with hydrocephalus and cerebrospinal fluid (CSF) diversion procedures. We hypothesized that there would be a detectable decrease in CSF diversion procedures performed during the COVID-19 pandemic, as compared to a pre-COVID-19 baseline.
Methods:
A chart review of all patients that underwent a CSF diversion procedure from March 2019 to February 2021 was performed at Ann and Robert H. Lurie Children's Hospital of Chicago. The pre-COVID-19 period was defined as March 2019 to February 2020 and the COVID-19 pandemic period was defined as March 2020 to February 2021. CSF diversion procedures included endoscopic third ventriculostomy (ETV), ETV/choroid plexus cauterization (CPC), initial shunt placement, shunt removal/replacement, shunt revision, and temporization procedures. Data included gender, race, ethnicity, insurance type, etiology of hydrocephalus, type of procedure, and whether the procedure was performed due to infection. Results: Overall, there was no significant difference in the absolute number of CSF diversion procedures performed when comparing the pre-COVID-19 and COVID-19 periods (244 and 238, respectively). Furthermore, there was no observed difference in the gender, ethnicity, or insurance status of children undergoing a CSF diversion procedure. There was, however, a significant increase in the number of procedures performed due to infection during the COVID-19 pandemic at our institution (p = 0.04).
Conclusion:
Unlike several other surgical conditions during the COVID-19 pandemic, a statistically significant change in CSF diversion procedures was not observed at our institution. The increased number of procedures for infection at our institution is likely multifactorial and will be investigated further.
