Prof. Dr. Rolf Sobottke // Rhein-Maas Clinic
Uncovering the effects COVID-19 on spinal surgery in Germany: A real-world inquiry using the German Spine Society (DWG) spine registry
Challenge
The COVID-19 pandemic caused major disruptions to acute and elective healthcare pathways globally. How the pandemic affected surgical spine care in Germany has, however, not yet been assessed in detail using multicentric data.
Solution
Together with Prof. Dr. Rolf Sobottke, MD, PhD – director of the Center for Orthopedics, Traumatology, and Reconstructive Surgery as well as attending surgeon for spinal surgery, neurosurgery, and specialty orthopedics at the Rhein-Maas Clinic in Aachen, Germany – RAYLYTIC performed an analysis of data derived from the German Spine Society (DWG) patient registry.
Outcome
The analysis has yielded a more nuanced depiction of spine surgery under pandemic conditions, which may help surgeons provide evidence-based treatment to vulnerable patient populations during public health crises.
Excerpt
The COVID-19 pandemic undoubtedly strained healthcare globally. Critically ill COVID patients surged into hospitals, seizing resources from acute and elective surgical care. But how exactly did this affect spinal surgical care in Germany?
Challenge: Major disruptions, unclear effects
When the COVID-19 pandemic arrived in Germany in early 2020, its effects reverberated through all facets of daily life. These were felt especially in the field of healthcare. Quickly evident was the fact that many healthcare facilities were underequipped to balance surges of critically ill patients with routine elective and acute surgical care.
The immense strain on established healthcare pathways ultimately revealed two striking deficiencies in Germany’s healthcare infrastructure: lagging digitalization and a shortage in skilled healthcare laborers.1 The former has intensified concerns about the availability of data useful in prioritizing surgical interventions and, ultimately, providing high-risk patient populations with adequate care in the face of public health crises.
While the pandemic’s effects on certain spinal surgical interventions, such as spinal fusion2, have already been investigated, the impact of the pandemic on spinal surgery as a whole has yet to be explored using multicentric registry data.3
Solution: German Spine Society (DWG) spine registry analysis
To gain more nuanced insights into the effect on the pandemic both on spinal surgery as a whole and on individual spinal pathologies, Prof. Dr. Sobottke partnered with RAYLYTIC to conducting an in-depth analysis of the registry data.
But working with the registry data presented its own set of challenges. To manage the amount, complexity, and volatility of the registry data, advanced data analysis methods were applied. Over 100 German hospitals and clinics were continually entering data while the analysis took place. To control for this change, identical clinics – or clinics present in the registry both before and after the start of the pandemic – were identified to include 96 clinics for the year 2019 and 2020.
Outcomes: Valuable information for vulnerable patients
The analysis of the patient registry showed that overall fewer surgical spinal interventions took place in 2020 than in 2019. Drops in the absolute number of interventions coincided with pandemic waves. In March and April 2019, there were up to 1250 less surgical interventions in April – a statistically significant drop – and around 750 fewer interventions in March. Additionally, patients with degenerative diseases experienced a notable drop in performed surgeries during the first pandemic wave. Critical patient categories such as tumors and infections were also characterized by a drop in surgical interventions.
These results have created a clearer, more nuanced depiction of elective and acute spinal surgery during the COVID-19 pandemic. The information gathered from the analysis of the complex data sourced from the DWG patient registry could contribute to substantiating the evidence-based treatment and improved prioritization of high-risk patient populations during public health emergencies.
The results of the analysis have been presented at leading conferences in spine and orthopedics, including the 73rd conference of the German Society for Neurosurgery in 2022 in Cologne, Germany as well as Eurospine 2022 in Milan, Italy as well as the yearly convention of the German Spine Society in 2022 in Berlin.
1 https://www.aicgs.org/2021/11/challenges-for-the-german-healthcare-system-in-the-covid-19-pandemic-and-beyond/
2 Abduljawwad, Nehad et al. (2023): Effects of the COVID-19 Pandemic on Spinal Fusion Procedures for Spinal Infections in a Nationwide Hospital Network in Germany.
3 Sobottke R, Teuben M, Siewe J, Afifi A. (2022): Two years COVID-19 pandemic waves: The impact on volume of spine surgery in Germany : A German Spine Registry (DWG) analysis. Brain Spine. 2022;2:101004. doi: 10.1016/j.bas.2022.101004. Epub 2022 Oct 13. PMCID: PMC9558780.