Why Did Delayed Spine Surgery Patients Not Reschedule?

Why did some COVID delayed spine surgery patients not reschedule and how did those canceled spine surgeries affect patients in terms of their preoperative diagnoses, neurological dysfunctions, and reasons for surgery deferment?

A team of researchers from NYU Langone Health in Manhattan dove into that question recently with their study, “COVID-19 pandemic and elective spinal surgery cancelations—what happens to the patients?” which was published in the August 2, 2021, edition of The Spine Journal. The retrospective case series collected data for 133 patients whose spine procedures were canceled due to a state-mandated suspension of elective surgeries from March to June 2020.

Charla R. Fischer, M.D., study co-author, director of Quality and Patient Safety, Spine Service, and associate professor of Orthopedic Surgery at the NYU Langone Department of Orthopedic Surgery and the NYU Grossman School of Medicine, explained the objectives of the study to OTW, “As soon as we had to cancel the cases, we wanted to keep track of those patients to make sure they were given as much information as possible. As we started to follow up on them after the elective cases were restarted, we noticed a lot of patients were not rescheduling.”

The investigators reached out via telephone to patients who had not rescheduled their canceled surgery as of January 31, 2021. The researchers divided patients into three groups: those who rescheduled early, rescheduled late, and those who did not reschedule. Those who rescheduled early were initially set to undergo surgery prior to the city’s COVID recovery Phase 4 reopening on July 20, 2020, while those who rescheduled late had a date of surgery on or after that date.

The researchers found that of the 133 patients, 47.4% (63) rescheduled early, 15.8% (21) rescheduled late, and 36.8% (49) did not reschedule. The “late reschedulers” had more three column osteotomies (14.3%) than the “early reschedulers” and (1.6%) and those who never rescheduled (2.0%), and fewer lumbar microdiscectomies (0%) compared to the “early reschedulers” (20.6%) and those who never rescheduled (10.2%). “Late reschedulers” had a longer length of stay than the “early reschedulers” (4.2 vs 2.4).

No one in early- or late-rescheduling groups had a nosocomial COVID-19 infection. Of those who never rescheduled, 2.0% have a future surgery date scheduled and 8.2% (4) are acquiring updated exams before rescheduling. 40.8% (20) continue to defer surgery over concern for COVID-19 exposure and 16.3% (8) for medical comorbidities. Three patients (6.1%) permanently canceled due to an improvement of symptom. Four patients (8.2%) had follow-up recommendations for non-surgical management, while two patients are since deceased (4.1%).

“The New York City (NYC) area was hit hard so early on in the pandemic,” said Dr. Fischer to OTW. As providers in NYC we need to understand that some patients changed their healthcare to entirely new locations due to either moving to a new area or avoiding returning to NYC.”