The adjustment of neurosurgical procedures during the COVID-19 pandemic: a case study at Dr. Sardjito General Hospital as a part of an academic health system

OBJECTIVE The recent COVID-19 outbreak has forced notable adjustments to surgical procedure preparation, includ-
ing neurosurgical services. However, due to the uniqueness of the recent situation, neurosurgical centers, especially
those located in low-resource settings, are facing several challenges such as a lack of coordination, poor equipment,
and shortage of medical personnel. Therefore, several guidelines from local authorities and international neurosurgical
bodies have been published to help clinicians manage their patients. In addition, the academic health system (AHS),
which is an integrated system containing a medical institution, universities, and a teaching hospital, may play some role
in the management of patients during COVID-19. The objective of this study was to describe how each hospital in the
authors’ network adjusted their neurosurgical practice and how the AHS of the Universitas Gadjah Mada (UGM) played
its role in the adaptation process during the pandemic.
METHODS The authors gathered both local and national data about the number of COVID-19 infections from the
government’s database. To assess the contribution of the AHS to the efforts of each hospital to address the pandemic,
questionnaires were given to 6 neurosurgeons, 1 resident, and 2 general surgeons about the management of neurosur-
gical cases during the pandemic in their hospitals.
RESULTS The data illustrate various strategies to manage neurosurgical cases by hospitals within the authors’ net-
works. The hospitals were grouped into three categories based on the transmission risk in each region. Most of these
hospitals stated that UGM AHS had a positive impact on the changes in their strategies. In the early phase of the out-
break, some hospitals faced a lack of coordination between hospitals and related stakeholders, inadequate amount of
personal protective equipment (PPE), and unclear regulations. As the nation enters a new phase, almost all hospitals
had performed routine screening tests, had a sufficient amount of PPE for the medical personnel, and followed both na-
tional and international guidelines in caring for their neurosurgical patients.
CONCLUSIONS The management of neurosurgical procedures during the outbreak has been a challenging task and a
role of the AHS in improving patient care has been experienced by most hospitals in the authors’ network. In the future,
the authors expect to develop a better collaboration for the next possible pandemic.
https://thejns.org/doi/abs/10.3171/2020.9.FOCUS20699
KEYWORDS COVID-19; academic health system; middle-income country; neurosurgical procedure; Indonesia